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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000869

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Adeline EthelSmith Sex Female

Date of Birth March 2, 1923 Place of Birth Prince Street, YarmouthCounty of Yarmouth

Name of Father Charles Edgar Smith MAIDEN NAME of Mother Mabel Louise Berry

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

Residence of Father when child was born Prince Street Yarmouth Ns Present address of Father Deceased

Occupation of Father at Birth of child Overseer of Spinning Room at Cotton Mill Place of birth of Father Yarmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ethel Adeline Smith Address of Applicant RR #1, South Ohio, Yarmouth Co., NS Date 1 September 1980

Relationship of Applicant to child Myself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Adeline EthelSmith

Born at Prince Street, Yarmouth in the County of Yarmouth

That Adeline EthelSmith Whose Birth is sought to be registered was

born at Prince Street, Yarmouth Yarmouth County on March 2, 1923

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

I was her eldest brother and was brought up with her.

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