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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000648

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Violet HazelBoomer Maynard Sex Female

Date of Birth October 17, 1922 Place of Birth BrookfieldCounty of Colchester

Name of Father   MAIDEN NAME of Mother Florence Letitia Boomer

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Florence L.. Maynard Address of Applicant Brookfield, Colchester Date 19 August 1977

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Violet HazelBoomer Maynard

Born at Brookfield in the County of Colchester

That Violet HazelBoomer Maynard Whose Birth is sought to be registered was

born at Brookfield Colchester County on October 17, 1922

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

I am her mother. The evidence from school and marriage records is in the surname Maynard, the surname of my husband to whom I was married after this birth and the surname by which she was commonly known

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