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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000711

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Doris KathleenGates Sex Female

Date of Birth December 14, 1921 Place of Birth FortiesCounty of Lunenburg

Name of Father Frank Gates MAIDEN NAME of Mother Bertha May Hiltz

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

Occupation of Father at Birth of child Farm Labourer Place of birth of Father Parker Road, Aylesford, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Edith M. Hiltz Address of Applicant Forties, Lunenburg Co., NS Date 22 May 1941

Relationship of Applicant to child Grandmother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Doris KathleenGates

Born at Forties in the County of Lunenburg

That Doris KathleenGates Whose Birth is sought to be registered was

born at Forties Lunenburg County on December 14, 1921

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

Being present at the birth with Mrs. Mary Hiltz

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