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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000171

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bernice IdellaRussell Sex Female

Date of Birth March 6, 1920 Place of Birth Pleasant RiverCounty of Queens

Name of Father Jabez Allen Russell MAIDEN NAME of Mother Mary Idella Silver

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

Residence of Father when child was born Pleasant River Present address of Father Simpsons Corner

Occupation of Father at Birth of child Farmer Place of birth of Father Hemford

Race Canadian Name and present address of Physician in attendance at birth

Signature of Applicant Bernice Russell Address of Applicant Dartmouth Date October 13, 1951

Relationship of Applicant to child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bernice IdellaRussell

Born at Pleasant River in the County of Queens

That Bernice IdellaRussell Whose Birth is sought to be registered was

born at Pleasant River Queens County on March 6, 1920

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

Bernice Idella Russell is my child in the affidavit to my knowledge of the facts of such birth is bared on the circumstances. Copy of Baptismal Certificate attached.

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