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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000947

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of M. AubelineForgeron Sex Female

Date of Birth October 8, 1920 Place of Birth West ArichatCounty of Richmond

Name of Father Abraham Forgeron MAIDEN NAME of Mother Stella Brillont

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

Residence of Father when child was born West Arichat Present address of Father deceased

Occupation of Father at Birth of child Common Labourer Place of birth of Father West Arichat

Race Name and present address of Physician in attendance at birth

Signature of Applicant M. Aubeline Forgeron Address of Applicant West Arichat Date December 29, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of M. AubelineForgeron

Born at West Arichat in the County of Richmond

That M. AubelineForgeron Whose Birth is sought to be registered was

born at West Arichat Richmond County on October 8, 1920

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

On the Certificate of Baptism

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