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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000373

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Thelma RetaWallace Sex Female

Date of Birth October 15, 1923 Place of Birth Starrs PointCounty of Kings

Name of Father William Edward Wallace MAIDEN NAME of Mother Amy Louise Chase

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

Residence of Father when child was born Kentville Kings Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Avonport, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant John P. Covert Address of Applicant 105 Exhibition Street, Kentville, Kings Co., NS Date 23 December 1969

Relationship of Applicant to child None

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Thelma RetaWallace

Born at Starrs Point in the County of Kings

That Thelma RetaWallace Whose Birth is sought to be registered was

born at Starrs Point Kings County on October 15, 1923

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

School record Bible record

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