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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000315

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 7, 1923 Place of Birth BerwickCounty of Kings

Name of Father Robert Owen Sullivan MAIDEN NAME of Mother Grace Sarah Woodworth

Residence of Father when child was born Berwick, Kings Co., NS Present address of Father Oxford, Pennsylvania, USA

Occupation of Father at Birth of child Moving Picture Operator Place of birth of Father Chattanooga, Tennessee, USA

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. R. O. Sullivan Address of Applicant Oxford, Pennsylvania, USA Date 30 July 1941

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Berwick in the County of Kings

That FrancesSullivan Whose Birth is sought to be registered was

born at Berwick Kings County on April 7, 1923

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

I am her mother

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