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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000435

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marjorie EllenPoole Sex Female

Date of Birth July 10, 1922 Place of Birth HalifaxCounty of Halifax

Name of Father Edgar Michael Poole MAIDEN NAME of Mother Annie May Lane

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

Residence of Father when child was born Souris, Prince Edward Island Present address of Father Deceased

Occupation of Father at Birth of child Stevedore Place of birth of Father Channel, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Annie May Poole Address of Applicant Souris, Prince Edward Island Date 12 November 1971

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marjorie EllenPoole

Born at Halifax in the County of Halifax

That Marjorie EllenPoole Whose Birth is sought to be registered was

born at Halifax Halifax County on July 10, 1922

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

I am the mother of the said Marjorie Ellen Poole

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