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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100155

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rita MaeWoodworth Sex Female

Date of Birth May 8, 1921 Place of Birth CentrevilleCounty of Kings

Name of Father Frank Woodworth MAIDEN NAME of Mother Blanche Bennett

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

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

Occupation of Father at Birth of child Farmer Place of birth of Father Baxters Harbour

Race Name and present address of Physician in attendance at birth

Signature of Applicant Rita Mae Woodworth Nicholson Address of Applicant RR4 Whycocomagh Date February 20, 1986

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rita MaeWoodworth

Born at Centreville in the County of Kings

That Rita MaeWoodworth Whose Birth is sought to be registered was

born at Centreville Kings County on May 8, 1921

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

I have examined the census records and the family bible of the Family of Rita Mae Woodworth

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