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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000338

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Alice NorineMansfield Sex Female

Date of Birth March 14, 1921 Place of Birth WestfieldCounty of Queens

Name of Father Dan Mansfield MAIDEN NAME of Mother Violet Ellis Martin

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

Residence of Father when child was born Westfield Present address of Father Clementsport

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

Race English Name and present address of Physician in attendance at birth Dr. March

Signature of Applicant Alice N. Blacklock Address of Applicant Clementsport Date November 9, 1964

Relationship of Applicant to child I am the child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Alice NorineMansfield

Born at Westfield in the County of Queens

That Alice NorineMansfield Whose Birth is sought to be registered was

born at Westfield Queens County on March 14, 1921

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

I am her mother. She is my only child. Dr. March neglected to register birth I am her Father. Dan Mansfield

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