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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000692

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary MelvinaFougere Sex Female

Date of Birth November 30, 1922 Place of Birth PoulamonCounty of Richmond

Name of Father James Joseph Fougere MAIDEN NAME of Mother Mary Victoria Fougere

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

Residence of Father when child was born Poulamon, Richmond Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Poulamon, Richmond

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Melvina LeBlanc Address of Applicant PO Box 253, Arichat, Richmond Date 23 June 1978

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary MelvinaFougere

Born at Poulamon in the County of Richmond

That Mary MelvinaFougere Whose Birth is sought to be registered was

born at Poulamon Richmond County on November 30, 1922

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

Certificate of birth

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