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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500756

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Sadie SamanthaDall Sex Female

Date of Birth August 20, 1922 Place of Birth Lower Sandy PointCounty of Shelburne

Name of Father John Dall MAIDEN NAME of Mother Nellie Goodick

Residence of Father when child was born Lower Sandy Point Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Lower Sandy Point

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Nellie Dall Address of Applicant Lower Sandy Point Date December 7, 1940

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Sadie SamanthaDall

Born at Lower Sandy Point in the County of Shelburne

That Sadie SamanthaDall Whose Birth is sought to be registered was

born at Lower Sandy Point Shelburne County on August 20, 1922

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

I am the Mother of Sadie Samantha Dall and therefore know that she was born at Lower Sandy Point on August 20, 1922

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