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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000906

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary CarmellaGates Sex Female

Date of Birth May 2, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father William Michael Gates MAIDEN NAME of Mother Marybelle Pembroke

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

Residence of Father when child was born New Aberdeen Present address of Father deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Carmella Gates Miller Address of Applicant 77 Brookland St. Antigonish Date October 22, 1980

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary CarmellaGates

Born at Glace Bay in the County of Cape Breton

That Mary CarmellaGates Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on May 2, 1921

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

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