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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000586

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of MaryAsseff Sex

Date of Birth December 20, 1920 Place of Birth South HarbourCounty of Victoria

Name of Father Joseph Asseff MAIDEN NAME of Mother Mary Ellen Fitzgerald

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

Residence of Father when child was born South Harbour Present address of Father deceased

Occupation of Father at Birth of child Merchant Place of birth of Father Lebanon

Race Caucasian Name and present address of Physician in attendance at birth None - Midwife

Signature of Applicant Mary Asseff Address of Applicant 499 Salisbury Road, Moncton, New Brunswick Date march 30, 1972

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of MaryAsseff

Born at South Harbour in the County of Victoria

That MaryAsseff Whose Birth is sought to be registered was

born at South Harbour Victoria County on December 20, 1920

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

That hereto annexed and marked "A" is the Baptismal Certificate of Mary Asseff aforesaid

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