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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000769

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marjorie GeorgenaDouglas Sex Female

Date of Birth October 22, 1921 Place of Birth MillsvilleCounty of Pictou

Name of Father John William Douglas MAIDEN NAME of Mother Etta Elizabeth Rae

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

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

Occupation of Father at Birth of child Lumberman Place of birth of Father Lairg

Race Name and present address of Physician in attendance at birth

Signature of Applicant John R. Neighton Address of Applicant 1 Elm St. E. Pictou Date 1 September 1978

Relationship of Applicant to child Husband

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marjorie GeorgenaDouglas

Born at Millsville in the County of Pictou

That Marjorie GeorgenaDouglas Whose Birth is sought to be registered was

born at Millsville Pictou County on October 22, 1921

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

Family Bible entry under "Births" What I have been told over the years by people who knew my wife (the applicant as a child.

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