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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000358

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Iola VivianLewis Sex Female

Date of Birth December 8, 1922 Place of Birth EdwardsvilleCounty of Cape Breton

Name of Father Earnest Weston Lewis MAIDEN NAME of Mother Myrtle Vine Ross

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

Residence of Father when child was born Edwardsville, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Coal Shipper Place of birth of Father Edwardsville, Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant Myrtle Vine Lewis Address of Applicant Edwardsville, Cape Breton Date 15 July 1968

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Iola VivianLewis

Born at Edwardsville in the County of Cape Breton

That Iola VivianLewis Whose Birth is sought to be registered was

born at Edwardsville Cape Breton County on December 8, 1922

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

I am the mother of Iola Vivian Lewis

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