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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000104

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of HazelRoy Sex Female

Date of Birth February 21, 1921 Place of Birth WestvilleCounty of Pictou

Name of Father William Roy MAIDEN NAME of Mother Minnie Nicholson

Residence of Father when child was born Westville, Pictou Co., NS Present address of Father Westville, Pictou Co., NS

Occupation of Father at Birth of child Miner Place of birth of Father Westville, Pictou Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Minnie Roy Address of Applicant Westville, Pictou Co., NS Date 5 February 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of HazelRoy

Born at Westville in the County of Pictou

That HazelRoy Whose Birth is sought to be registered was

born at Westville Pictou County on February 21, 1921

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

That I am her mother

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