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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000726

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rita AmandaRomans Sex Female

Date of Birth January 26, 1921 Place of Birth Hammonds PlainsCounty of Halifax

Name of Father Scott Livingstone Romans MAIDEN NAME of Mother Amanda Laura Bontiker

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

Residence of Father when child was born Hammonds Plains Present address of Father deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Hammonds Plains

Race Name and present address of Physician in attendance at birth

Signature of Applicant Rita McLellan Address of Applicant RR2 Site 50 Comp 7 Bedford Date January 27, 1978

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rita AmandaRomans

Born at Hammonds Plains in the County of Halifax

That Rita AmandaRomans Whose Birth is sought to be registered was

born at Hammonds Plains Halifax County on January 26, 1921

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

Baptismal

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