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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100405

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 3, 1920 Place of Birth InvernessCounty of Inverness

Name of Father James Edward Clark MAIDEN NAME of Mother Mariah Burke

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

Residence of Father when child was born Inverness Present address of Father

Occupation of Father at Birth of child Place of birth of Father Victoria Village, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Speaving Address of Applicant Glace Bay Date December 10, 1997

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary Bryce VictoriaClark

Born at Inverness in the County of Inverness

That Mary Bryce VictoriaClark Whose Birth is sought to be registered was

born at Inverness Inverness County on June 3, 1920

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

Copy of Baptismal Certificate and Verified copy of Church Records

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