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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000279

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy IreneNickerson Sex Female

Date of Birth March 10, 1924 Place of Birth LiverpoolCounty of Queens

Name of Father Hubert Granville Nickerson MAIDEN NAME of Mother Freda Edith Cox

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

Residence of Father when child was born Liverpool, Queens Co., NS Present address of Father Liverpool, Queens Co., NS

Occupation of Father at Birth of child Merchant Place of birth of Father Clark's Harbour, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Freda Nickerson Address of Applicant Liverpool, Queens Co., NS Date 26 January 1965

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy IreneNickerson

Born at Liverpool in the County of Queens

That Dorothy IreneNickerson Whose Birth is sought to be registered was

born at Liverpool Queens County on March 10, 1924

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

Entry in family bible - certificate attached Record of attendance at Liverpool School - certificate attached

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