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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000181

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roxie GladysBartlett Sex Female

Date of Birth August 11, 1924 Place of Birth ValleyCounty of Colchester

Name of Father Charles Prescott Bartlett MAIDEN NAME of Mother Dora Agnes Pyke

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

Residence of Father when child was born Valley, Colchester Co., NS Present address of Father Valley, Colchester Co., NS

Occupation of Father at Birth of child Farmer Place of birth of Father Valley, Colchester Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dora Agnes Bartlett Address of Applicant RR #2, Truro, Colchester Co., NS Date 15 August 1956

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roxie GladysBartlett

Born at Valley in the County of Colchester

That Roxie GladysBartlett Whose Birth is sought to be registered was

born at Valley Colchester County on August 11, 1924

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

1. I am the mother of the said Roxie Gladys Bartlett 2. National Registration record School record

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