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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000916

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 11, 1920 Place of Birth JogginsCounty of Cumberland

Name of Father Jules Blondois MAIDEN NAME of Mother Georgina Boudreau

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

Residence of Father when child was born Joggins Present address of Father dead

Occupation of Father at Birth of child Coal Miner Place of birth of Father Brussels, Belgium

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Elizabeth Burke Address of Applicant Blairmore, Alberta Date April 17, 1978

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Joggins in the County of Cumberland

That Mary ElizabethBlondois Whose Birth is sought to be registered was

born at Joggins Cumberland County on May 11, 1920

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

As per particulars contained on the baptismal certificate attached.

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