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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000992

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Adella WinifredMartin Sex Female

Date of Birth February 20, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father Bernard Martin MAIDEN NAME of Mother Winifred Falloon

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

Residence of Father when child was born 78 Duncan St. Halifax Present address of Father dead

Occupation of Father at Birth of child Unemployed Place of birth of Father Canada

Race Name and present address of Physician in attendance at birth

Signature of Applicant Adele J. Menzie Address of Applicant East Berne, New York, USA Date September 3, 1982

Relationship of Applicant to child Myself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Adella WinifredMartin

Born at Halifax in the County of Halifax

That Adella WinifredMartin Whose Birth is sought to be registered was

born at Halifax Halifax County on February 20, 1921

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

By information from St. Josephs Church 5455 Russell St. Halifax

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