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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000003

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Irene MaePleasant Sex Female

Date of Birth September 4, 1922 Place of Birth YarmouthCounty of Yarmouth

Name of Father   MAIDEN NAME of Mother Mary Elizabeth Pleasant

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 Mary E. Pleasant Address of Applicant Yarmouth Date 12 December 1946

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Irene MaePleasant

Born at Yarmouth in the County of Yarmouth

That Irene MaePleasant Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on September 4, 1922

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

I am the mother of Irene Mae Pleasant

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