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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000646

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gerald GeorgeMuise Sex Male

Date of Birth August 26, 1922 Place of Birth WedgeportCounty of Yarmouth

Name of Father   MAIDEN NAME of Mother Mabel Muise

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 Gerald George Muise Address of Applicant Wedgeport, Yarmouth Date 28 July 1977

Relationship of Applicant to child Child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gerald GeorgeMuise

Born at Wedgeport in the County of Yarmouth

That Gerald GeorgeMuise Whose Birth is sought to be registered was

born at Wedgeport Yarmouth County on August 26, 1922

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

Court order under Vital Statistics Act

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