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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000853

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Phyllis Wynne AugustaBlanch Sex Female

Date of Birth September 11, 1921 Place of Birth AmherstCounty of Cumberland

Name of Father George F. Blanch MAIDEN NAME of Mother Lieb E. Vallance

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

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

Occupation of Father at Birth of child Restaurant Operator Place of birth of Father Shemogue, New Brunswick

Race Name and present address of Physician in attendance at birth

Signature of Applicant A.C. Langille Address of Applicant 52 Prince Arthur St. Amherst Date September 29, 1979

Relationship of Applicant to child Husband

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Phyllis Wynne AugustaBlanch

Born at Amherst in the County of Cumberland

That Phyllis Wynne AugustaBlanch Whose Birth is sought to be registered was

born at Amherst Cumberland County on September 11, 1921

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

Certificate of Birth and Baptism

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