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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900171

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bertha MadolaGoreham Sex Female

Date of Birth January 24, 1920 Place of Birth Lower Woods HarbourCounty of Shelburne

Name of Father Frank Goreham MAIDEN NAME of Mother Bertha Sears

Residence of Father when child was born Lower Woods Harbour Present address of Father Lower Woods Harbour

Occupation of Father at Birth of child Fisherman Place of birth of Father Lower Woods Harbour

Race English Name and present address of Physician in attendance at birth Dr. H.H. Banks (deceased)

Signature of Applicant Bertha Goreham Address of Applicant Lower Woods Harbour Date February 28, 1945

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bertha MadolaGoreham

Born at Lower Woods Harbour in the County of Shelburne

That Bertha MadolaGoreham Whose Birth is sought to be registered was

born at Lower Woods Harbour Shelburne County on January 24, 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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