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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000157

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Winifred IrenePotter Sex Female

Date of Birth October 30, 1922 Place of Birth MeadowvaleCounty of Annapolis

Name of Father Manning R. Potter MAIDEN NAME of Mother Mary Elizabeth Potter

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

Residence of Father when child was born Meadowvale, Annapolis Present address of Father RR 2, Wilmot, Meadowvale, Annapolis

Occupation of Father at Birth of child Farmer Place of birth of Father Clementsvale, Annapolis

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary E. Potter Address of Applicant Wilmot Station, Annapolis Date March 1953

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Winifred IrenePotter

Born at Meadowvale in the County of Annapolis

That Winifred IrenePotter Whose Birth is sought to be registered was

born at Meadowvale Annapolis County on October 30, 1922

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

That I am the mother of the said Winifred Irene Potter and I well recall the date and fact of her birth. (baby birthday book record and supporting declarations)

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