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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000258

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Margery Jean CreightonBlack Sex Female

Date of Birth March 3, 1921 Place of Birth AbercrombieCounty of Pictou

Name of Father John Henry Black MAIDEN NAME of Mother Gertrude Beatrice Curren

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

Residence of Father when child was born Abercrombie Present address of Father 6 Le Marchant St. Halifax

Occupation of Father at Birth of child Farmer Place of birth of Father Dartmouth

Race Canadian Name and present address of Physician in attendance at birth Dr. John W. MacKay

Signature of Applicant John Henry Black Address of Applicant 6 LeMarchant St. Halifax Date June 15, 1958

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Margery Jean CreightonBlack

Born at Abercrombie in the County of Pictou

That Margery Jean CreightonBlack Whose Birth is sought to be registered was

born at Abercrombie Pictou County on March 3, 1921

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

I am her father and was living at Abercrombie on that day The spelling of Margery in the Certificate of Baptism is incorrect J.H. Black Correct spelling is Margery J.H.B.

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