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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93401171

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 6, 1906 Place of Birth WestvilleCounty of Pictou

Name of Father David Henderson MAIDEN NAME of Mother Annie Wallace

Residence of Father when child was born Westville Present address of Father New Glasgow

Occupation of Father at Birth of child Miner Place of birth of Father Westville

Race Scottish Name and present address of Physician in attendance at birth Dr. Clyde McDonald

Signature of Applicant Mary Evelyn Henderson Address of Applicant New Glasgow Date 26 January 1926

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Westville in the County of Pictou

That Mary EvelynHenderson Whose Birth is sought to be registered was

born at Westville Pictou County on January 6, 1906

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

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