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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000719

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Louise IsaBlack Sex Female

Date of Birth August 17, 1921 Place of Birth SalemCounty of Cumberland

Name of Father Warren Cutler Black MAIDEN NAME of Mother Alice Jane Chappell

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Louise Hollis Address of Applicant RR3 Amherst Date July 4, 1977

Relationship of Applicant to child Applicant is the child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Louise IsaBlack

Born at Salem in the County of Cumberland

That Louise IsaBlack Whose Birth is sought to be registered was

born at Salem Cumberland County on August 17, 1921

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

She was born to me; my first born. I gave birth to her at Salem, at my husbands mothers home. My husbands mother was Adelia Black, wife of William Black.

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