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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000647

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary LouisePettipas Sex Female

Date of Birth December 1, 1921 Place of Birth ArichatCounty of Richmond

Name of Father Walter Petitpas MAIDEN NAME of Mother Eugenie Briand

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

Residence of Father when child was born Arichat Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Arichat

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Matt Furlong Address of Applicant 1216 George St. Sydney Date August 18, 1976

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary LouisePettipas

Born at Arichat in the County of Richmond

That Mary LouisePettipas Whose Birth is sought to be registered was

born at Arichat Richmond County on December 1, 1921

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

Baptismal Certificate

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