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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000625

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rose AnneMuise Sex Female

Date of Birth August 16, 1922 Place of Birth Roberts IslandCounty of Yarmouth

Name of Father William Edward Muise MAIDEN NAME of Mother Mary Jane Surette

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Wakefield, Massachusetts, USA Present address of Father Deceased

Occupation of Father at Birth of child Coal Worker Place of birth of Father Yarmouth

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Rose A. LeBlanc Address of Applicant RR #1, Box 1090, Arcadia, Yarmouth Date February 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rose AnneMuise

Born at Roberts Island in the County of Yarmouth

That Rose AnneMuise Whose Birth is sought to be registered was

born at Roberts Island Yarmouth County on August 16, 1922

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

I am her mother

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