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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000855

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of MaryBeals Sex Female

Date of Birth December 24, 1921 Place of Birth North PrestonCounty of Halifax

Name of Father Thomas Beals MAIDEN NAME of Mother Eva Downey

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

Residence of Father when child was born North Preston Present address of Father deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Harry Simmons Address of Applicant Box 13 Site 7 North Preston Date October 1979

Relationship of Applicant to child same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of MaryBeals

Born at North Preston in the County of Halifax

That MaryBeals Whose Birth is sought to be registered was

born at North Preston Halifax County on December 24, 1921

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

School Record

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