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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100187

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bernita PearlEmbree Sex Female

Date of Birth December 5, 1921 Place of Birth Port HawkesburyCounty of Inverness

Name of Father Ormond Isaiah Embree MAIDEN NAME of Mother Charlotte Mary Banfield

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

Residence of Father when child was born Port Hawkesbury Present address of Father deceased

Occupation of Father at Birth of child Ferryman Place of birth of Father Port Hawkesbury

Race Name and present address of Physician in attendance at birth

Signature of Applicant Pearl B. Embree Address of Applicant 436 Herring Cove Rd. Halifax Date October 9, 1986

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bernita PearlEmbree

Born at Port Hawkesbury in the County of Inverness

That Bernita PearlEmbree Whose Birth is sought to be registered was

born at Port Hawkesbury Inverness County on December 5, 1921

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

Baptism Certificate I am her Mother

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