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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000766

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Florence KathleenDolliver Sex Female

Date of Birth January 6, 1922 Place of Birth Port MedwayCounty of Queens

Name of Father Harris Wagner Dolliver MAIDEN NAME of Mother Viola Almira Tufts

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

Residence of Father when child was born Port Medway, Queens Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Port Medway, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant Florence Kathleen Tarr Address of Applicant RR #1, Liverpool, Queens Date July 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Florence KathleenDolliver

Born at Port Medway in the County of Queens

That Florence KathleenDolliver Whose Birth is sought to be registered was

born at Port Medway Queens County on January 6, 1922

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

1. I was informed by my mother and my late father that my date of birth was January 6th, 1922. My birthdays were always observed on the 6th day of January and my age has always been consistent with my birth in 1922. 2. I annex my baptismal certificate (Class "A") as schedule A of my affidavit.

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