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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000434

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bernice KathrineMaryatt Sex Female

Date of Birth September 5, 1922 Place of Birth SambroCounty of Halifax

Name of Father Samuel W. Marryatt MAIDEN NAME of Mother Grace marryatt

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

Residence of Father when child was born Long Cove, Sambro, Halifax Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Long Cove, Sambro, Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Bernice K. Burt Address of Applicant 3527 Albert Street, Halifax Date 9 November 1971

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bernice KathrineMaryatt

Born at Sambro in the County of Halifax

That Bernice KathrineMaryatt Whose Birth is sought to be registered was

born at Sambro Halifax County on September 5, 1922

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

Baptismal certificate

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