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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000213

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth July 29, 1921 Place of Birth D'EscousseCounty of Richmond

Name of Father Simon Burke MAIDEN NAME of Mother Josephine McDonald

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

Residence of Father when child was born D'Escousse Present address of Father deceased

Occupation of Father at Birth of child Cook Place of birth of Father D'Escousse

Race White Name and present address of Physician in attendance at birth Dr. B.H. LeBlanc

Signature of Applicant Mary Ina Mathilda Burke Address of Applicant 25 Hennessey Place Date October 31, 1955

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary Ina MathildaBurke

Born at D'Escousse in the County of Richmond

That Mary Ina MathildaBurke Whose Birth is sought to be registered was

born at D'Escousse Richmond County on July 29, 1921

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

Baptism

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