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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100084

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Douglas LeroiDale Sex Male

Date of Birth May 20, 1922 Place of Birth ChignectoCounty of Cumberland

Name of Father James Sherden Dale MAIDEN NAME of Mother Letisha Isabel Seaman

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

Residence of Father when child was born Chignecto, Cumberland Present address of Father Deceased

Occupation of Father at Birth of child Miner Place of birth of Father Harcourt, New Brunswick

Race Name and present address of Physician in attendance at birth

Signature of Applicant Doris Price Address of Applicant 123 Maple Street, Stellarton, Pictou Date 18 February 1987

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Douglas LeroiDale

Born at Chignecto in the County of Cumberland

That Douglas LeroiDale Whose Birth is sought to be registered was

born at Chignecto Cumberland County on May 20, 1922

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

Record of Baptism, United Church of Canada, Nappan.

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