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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90501732

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary RitaWillis Sex Female

Date of Birth June 15, 1920 Place of Birth AntigonishCounty of Antigonish

Name of Father William Willia MAIDEN NAME of Mother Mary Willis

Residence of Father when child was born Antigonish Present address of Father Antigonish

Occupation of Father at Birth of child Sectionman, Canadian National Railway Place of birth of Father St. John, New Brunswick

Race White Name and present address of Physician in attendance at birth Dr. J. L. McIsaac, Antigonish

Signature of Applicant Mary Willis Address of Applicant Antigonish Date 4 March 1940

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary RitaWillis

Born at Antigonish in the County of Antigonish

That Mary RitaWillis Whose Birth is sought to be registered was

born at Antigonish Antigonish County on June 15, 1920

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

I am her mother

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