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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000551

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Eileen MarieSmith Sex Female

Date of Birth August 4, 1921 Place of Birth AmherstCounty of Cumberland

Name of Father Osborne Edward Smith MAIDEN NAME of Mother Daphne Agnes Blanch

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

Residence of Father when child was born 10 Davison St. Amherst Present address of Father deceased

Occupation of Father at Birth of child Drug Clerk Place of birth of Father Shinimicas

Race English Name and present address of Physician in attendance at birth Dr. J.A. Munro

Signature of Applicant Eileen Marie Smith MacNeil Address of Applicant Box 8 Whitney Pier Date April 1, 1974

Relationship of Applicant to child Seeking registration for myself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Eileen MarieSmith

Born at Amherst in the County of Cumberland

That Eileen MarieSmith Whose Birth is sought to be registered was

born at Amherst Cumberland County on August 4, 1921

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

Attached is original Certificate of Registration of Birth which was not forwarded to Halifax at time of birth

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