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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000779

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mae BeatriceJohnson Sex Female

Date of Birth November 12, 1921 Place of Birth TimberleaCounty of Halifax

Name of Father Robert Johnson MAIDEN NAME of Mother Beatrice Feit

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Williams Burns Address of Applicant 6291 Chebucto Rd. Halifax Date December 15, 1978

Relationship of Applicant to child Son

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mae BeatriceJohnson

Born at Timberlea in the County of Halifax

That Mae BeatriceJohnson Whose Birth is sought to be registered was

born at Timberlea Halifax County on November 12, 1921

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

Baptism Certificate

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