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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000236

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mildred AdeliaBollivar Sex Female

Date of Birth September 21, 1924 Place of Birth Upper LaHaveCounty of Lunenburg

Name of Father Sydney Hiram Bollivar MAIDEN NAME of Mother Lucretia Utvilla Dares

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

Residence of Father when child was born Upper LaHave, Lunenburg Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Upper LaHave, Lunenburg Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mildred A. Eisenhauer Address of Applicant Hammonds Plains, Halifax Co., NS Date 21 April 1961

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mildred AdeliaBollivar

Born at Upper LaHave in the County of Lunenburg

That Mildred AdeliaBollivar Whose Birth is sought to be registered was

born at Upper LaHave Lunenburg County on September 21, 1924

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

Certificate of Baptism

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