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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000528

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Madeline AzeleLeBlanc Sex Female

Date of Birth June 19, 1922 Place of Birth WedgeportCounty of Yarmouth

Name of Father   MAIDEN NAME of Mother Elizabeth LeBlanc

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 Janice Surette Address of Applicant 3 Glenora Avenue, Halifax Date 12 February 1975

Relationship of Applicant to child Friend

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Madeline AzeleLeBlanc

Born at Wedgeport in the County of Yarmouth

That Madeline AzeleLeBlanc Whose Birth is sought to be registered was

born at Wedgeport Yarmouth County on June 19, 1922

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

Baptismal certificate and extract from marriage record.

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