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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93401029

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lorna GraceLong Sex Female

Date of Birth March 6, 1906 Place of Birth Black RiverCounty of Kings

Name of Father Rupert Grant Long MAIDEN NAME of Mother Inez Melvina Atwell

Residence of Father when child was born Black River Present address of Father White Rock

Occupation of Father at Birth of child Lumbering Place of birth of Father Black River

Race white Name and present address of Physician in attendance at birth Mrs. James Long, midwife

Signature of Applicant Inez Melvina Long Address of Applicant White Rock Date 23 December 1925

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lorna GraceLong

Born at Black River in the County of Kings

That Lorna GraceLong Whose Birth is sought to be registered was

born at Black River Kings County on March 6, 1906

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

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