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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000409

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 12, 1923 Place of Birth StellartonCounty of Pictou

Name of Father David Cullen Semple MAIDEN NAME of Mother Hazel Osborn

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

Residence of Father when child was born Asphalt Stellarton Pictou Co. Ns Present address of Father Asphalt, Stellarton, Pictou Co., NS

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant David C. Semple Address of Applicant Asphalt, Stellarton, Pictou Co., NS Date 27 October 1923

Relationship of Applicant to child Father

AFFIDAVIT

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

Born at Stellarton in the County of Pictou

That LillianSemple Whose Birth is sought to be registered was

born at Stellarton Pictou County on September 12, 1923

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

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