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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000501

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 4, 1920 Place of Birth Hazel Hill or CansoCounty of Guysborough

Name of Father Jack [or John] Groen MAIDEN NAME of Mother Bertha Rossong

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

Residence of Father when child was born Hazel Hill Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Germany

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

Signature of Applicant Mary E. Ewart Address of Applicant Kingston, Ontario Date April 1969

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Hazel Hill or Canso in the County of Guysborough

That Mary ElsieGroen Whose Birth is sought to be registered was

born at Hazel Hill or Canso Guysborough County on April 4, 1920

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

After being orphaned while I was a baby, in which I lived with my Aunt and Uncle, "Now Deceased" I have at this time no other way of getting further information, except my Birth and Baptism Certificate

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