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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100019

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 2, 1921 Place of Birth YarmouthCounty of Yarmouth

Name of Father   MAIDEN NAME of Mother Columba Cora Doucette

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Natalie Nicols Address of Applicant 1270 Tower Rd. Halifax Date July 26, 1983

Relationship of Applicant to child Granddaughter

AFFIDAVIT

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

Born at Yarmouth in the County of Yarmouth

That Mary LouiseDoucette Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on October 2, 1921

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

Baptismal Marriage Extract

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