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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700583

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gwendolyn ElizabethGates Sex Female

Date of Birth June 17, 1921 Place of Birth MiltonCounty of Queens

Name of Father A. Avery Gates MAIDEN NAME of Mother Eva Edna Smallman

Residence of Father when child was born Milton, Queens Co., NS Present address of Father Stoughton, Massachusetts, USA

Occupation of Father at Birth of child Clergyman Place of birth of Father Blandford, Lunenburg Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Eva S. Gates (Mrs. A. Avery) Address of Applicant 225 Plain Street, Stoughton, Massachusetts, USA Date 15 March 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gwendolyn ElizabethGates

Born at Milton in the County of Queens

That Gwendolyn ElizabethGates Whose Birth is sought to be registered was

born at Milton Queens County on June 17, 1921

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

As mother of Gwendolyn

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