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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700519

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 13, 1922 Place of Birth DartmouthCounty of Halifax

Name of Father   MAIDEN NAME of Mother Gladys Dalton

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 Gladys Dalton Address of Applicant Bridgewater, Lunenburg Co., NS Date 26 August 1943

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Dartmouth in the County of Halifax

That Douglas VincentDalton Whose Birth is sought to be registered was

born at Dartmouth Halifax County on June 13, 1922

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

That I am the mother of the said Douglas Vincent Dalton and have personal knowledge of date of birth.

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