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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000723

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Doris AnnabellInnis Sex Female

Date of Birth April 17, 1922 Place of Birth HalifaxCounty of Halifax

Name of Father   MAIDEN NAME of Mother Alice Innis

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 Doris A. Goodman Address of Applicant 14 Melvin Drive, Halifax Date 21 February 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Doris AnnabellInnis

Born at Halifax in the County of Halifax

That Doris AnnabellInnis Whose Birth is sought to be registered was

born at Halifax Halifax County on April 17, 1922

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

Baptism and extract from marriage

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