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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000229

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Helen MoletaCarver Sex Female

Date of Birth October 29, 1922 Place of Birth DevonshireCounty of Queens

Name of Father John Seldon Carver MAIDEN NAME of Mother Annie Coade

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Devonshire, Queens Present address of Father Caledonia, Queens

Occupation of Father at Birth of child Woodsman Place of birth of Father West Caledonia, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant John S. Carver Address of Applicant Caledonia, Queens Date 14 December 1957

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Helen MoletaCarver

Born at Devonshire in the County of Queens

That Helen MoletaCarver Whose Birth is sought to be registered was

born at Devonshire Queens County on October 29, 1922

My knowledge of the fact and date of such Birth is based on the following Circumstances:

I have her certificate of baptism, which is enclosed herewith. I am her father.

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