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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000255

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Anita RosalieCharlton Sex Female

Date of Birth March 16, 1921 Place of Birth Maitland BridgeCounty of Annapolis

Name of Father Alvin A. Charlton MAIDEN NAME of Mother Mabel L. Orde

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

Residence of Father when child was born Maitland Bridge Present address of Father Maitland Bridge

Occupation of Father at Birth of child Labourer Place of birth of Father Graywood

Race White Name and present address of Physician in attendance at birth Dr. McLeod

Signature of Applicant Mabel L. Charlton Address of Applicant Maitland Bridge Date March 31, 1958

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Anita RosalieCharlton

Born at Maitland Bridge in the County of Annapolis

That Anita RosalieCharlton Whose Birth is sought to be registered was

born at Maitland Bridge Annapolis County on March 16, 1921

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

I have examined both the record of the Family Bible and the School register containing the age of Anita Rosalie Charlton given as March 16, 1921 and found these records correct.

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