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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000746

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gussie JanePelly Sex Female

Date of Birth April 1, 1922 Place of Birth AntigonishCounty of Antigonish

Name of Father James Leslie Pelly MAIDEN NAME of Mother Eva Ashe

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

Residence of Father when child was born Antigonish Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Antigonish

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gussie Jane DeYoung Address of Applicant 60 St. Andrews Street, Antigonish Date 17 April 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gussie JanePelly

Born at Antigonish in the County of Antigonish

That Gussie JanePelly Whose Birth is sought to be registered was

born at Antigonish Antigonish County on April 1, 1922

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

Census data - copy attached

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