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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000888

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Alice MaryWorthen Sex Female

Date of Birth July 25, 1921 Place of Birth RiverheadCounty of Shelburne

Name of Father Joel Austin Worthen MAIDEN NAME of Mother Vida Aurelia Madden

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Alice Mary Atwood Address of Applicant RR1 Barrington Date August 24, 1979

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Alice MaryWorthen

Born at Riverhead in the County of Shelburne

That Alice MaryWorthen Whose Birth is sought to be registered was

born at Riverhead Shelburne County on July 25, 1921

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

I married Alice Mary Worthen on Nov 28, 1936 and at that time it was determined that she was indeed born on July 25th, 1921

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