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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000549

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Erma WilenaClark Sex Female

Date of Birth June 26, 1921 Place of Birth StellartonCounty of Pictou

Name of Father Herbert Henry Clark MAIDEN NAME of Mother Viola MacLeod

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

Residence of Father when child was born Stellarton Present address of Father Stellarton

Occupation of Father at Birth of child Coal Miner Place of birth of Father Stellarton

Race Canadian Name and present address of Physician in attendance at birth Dr. Day Throburn

Signature of Applicant Erma Wilena Scott Address of Applicant 24 Bridge Ave. Stellarton Date April 29, 1974

Relationship of Applicant to child Myself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Erma WilenaClark

Born at Stellarton in the County of Pictou

That Erma WilenaClark Whose Birth is sought to be registered was

born at Stellarton Pictou County on June 26, 1921

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

Baptismal Certificate already sent in

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