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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000065

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Agnes AntonetteMuise Sex Female

Date of Birth September 26, 1920 Place of Birth BrooklynCounty of Yarmouth

Name of Father Nathaniel  Muise MAIDEN NAME of Mother Frances Mary Saulnier

Residence of Father when child was born Brooklyn Present address of Father Dayton

Occupation of Father at Birth of child Cotton Mill Place of birth of Father Comeau Hill

Race French Name and present address of Physician in attendance at birth Dr. S.W. Williamson

Signature of Applicant Nathaniel Muise Address of Applicant Dayton Date April 9, 1946

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Agnes AntonetteMuise

Born at Brooklyn in the County of Yarmouth

That Agnes AntonetteMuise Whose Birth is sought to be registered was

born at Brooklyn Yarmouth County on September 26, 1920

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

I am the father of Agnes Antonette Muise

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