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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100049

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bernice EthelBenjamin Sex Female

Date of Birth November 25, 1921 Place of Birth WolfvilleCounty of Kings

Name of Father Clarence Benjamin MAIDEN NAME of Mother Evangeline Valentine Morine

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Bernice Ethel Smith Address of Applicant 10813 Commercial St. New Minas Date 14 May 1984

Relationship of Applicant to child Same Person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bernice EthelBenjamin

Born at Wolfville in the County of Kings

That Bernice EthelBenjamin Whose Birth is sought to be registered was

born at Wolfville Kings County on November 25, 1921

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

Advice of parents and Statistics Reports

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