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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000560

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Grace ViolaSheppard Sex Female

Date of Birth October 18, 1922 Place of Birth New GlasgowCounty of Pictou

Name of Father William Howard Sheppard MAIDEN NAME of Mother Laura Collins

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

Residence of Father when child was born New Glasgow, Pictou Present address of Father 620 Chisholm Street, New Glasgow, Pictou

Occupation of Father at Birth of child Brick Layer Place of birth of Father New Glasgow, Pictou

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Grace Douglas Address of Applicant 620 Chisholm Street, New Glasgow, Pictou Date 29 December 1975

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Grace ViolaSheppard

Born at New Glasgow in the County of Pictou

That Grace ViolaSheppard Whose Birth is sought to be registered was

born at New Glasgow Pictou County on October 18, 1922

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

School records and marriage record.

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