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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900536

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 21, 1921 Place of Birth DartmouthCounty of Halifax

Name of Father William Bauld MAIDEN NAME of Mother Rebecca Lee

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

Residence of Father when child was born 33 Prince Albert Road, Dartmouth, NS Present address of Father 33 Prince Albert Road, Dartmouth, NS

Occupation of Father at Birth of child Teamster Place of birth of Father Dartmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Rebecca Bauld Address of Applicant 33 Prince Albert Road, Dartmouth, NS Date 31 October 1945

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Dartmouth in the County of Halifax

That Douglas FairbankBauld Whose Birth is sought to be registered was

born at Dartmouth Halifax County on April 21, 1921

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

I am his lawful mother and have his date of birth recorded in my family bible

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