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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000664

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bessie OliviaFancy Sex Female

Date of Birth March 5, 1922 Place of Birth North BrookfieldCounty of Queens

Name of Father Maurice Elmer Fancy MAIDEN NAME of Mother Mary emily Goucher

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

Residence of Father when child was born North Brookfield, Queens Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father North Brookfield, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant Isla Agnes Goucher Address of Applicant Caledonia, Queens Date 10 November 1977

Relationship of Applicant to child Aunt on mothers side

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bessie OliviaFancy

Born at North Brookfield in the County of Queens

That Bessie OliviaFancy Whose Birth is sought to be registered was

born at North Brookfield Queens County on March 5, 1922

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

I was requested by my sister, the mother of Bessie Olivia Fancy, to assist her at the time of the birth but was unable to attend because of being pregnant. I gave birth to my daughter Margaret on April 22, 1922. I well remember the date of the birth of Bessie Olivia Fancy.

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