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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500682

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Evelyn PaulineSmith Sex Female

Date of Birth September 24, 1921 Place of Birth Maitland BridgeCounty of Annapolis

Name of Father Rolfe Smith MAIDEN NAME of Mother Dorothy E. Minard

Residence of Father when child was born Maitland Bridge Present address of Father Timmonds, Ontario

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dorothy E. Smith Address of Applicant Caledonia Date September 3, 1940

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Evelyn PaulineSmith

Born at Maitland Bridge in the County of Annapolis

That Evelyn PaulineSmith Whose Birth is sought to be registered was

born at Maitland Bridge Annapolis County on September 24, 1921

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

That I am the Mother of the person concerned

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