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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000604

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lucy JaneMould Sex Female

Date of Birth March 3, 1922 Place of Birth Baddeck InletCounty of Victoria

Name of Father   MAIDEN NAME of Mother Mary Florence Mould

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 D. H. Johnson Address of Applicant Johnston Building, Halifax Date 27 October 1976

Relationship of Applicant to child None

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lucy JaneMould

Born at Baddeck Inlet in the County of Victoria

That Lucy JaneMould Whose Birth is sought to be registered was

born at Baddeck Inlet Victoria County on March 3, 1922

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

Certification attached

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