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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000613

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rita ElizabethChiasson Sex Female

Date of Birth October 21, 1920 Place of Birth Margaree ForksCounty of Inverness

Name of Father Mosie F. Chiasson MAIDEN NAME of Mother Mary Ann Doucet

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

Residence of Father when child was born Margaree Forks Present address of Father Margaree Forks

Occupation of Father at Birth of child Farmer Place of birth of Father Margaree Forks

Race French Name and present address of Physician in attendance at birth Dr. Mose McGarry

Signature of Applicant Rita Elizabeth Chiasson Address of Applicant Arichat Date October 27, 1972

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rita ElizabethChiasson

Born at Margaree Forks in the County of Inverness

That Rita ElizabethChiasson Whose Birth is sought to be registered was

born at Margaree Forks Inverness County on October 21, 1920

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

As my father Mosie F. Chiasson was present at the date of my birth.

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