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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000881

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Phyllis MadelineMorine Sex Female

Date of Birth October 20, 1922 Place of Birth AvonportCounty of Kings

Name of Father Archibald Morine MAIDEN NAME of Mother Viola MacDow

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

Residence of Father when child was born Avonport, Kings Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Kings County

Race Name and present address of Physician in attendance at birth

Signature of Applicant Phyllis Taylor Address of Applicant RR #1, Walton, Hants Date 25 March 1982

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Phyllis MadelineMorine

Born at Avonport in the County of Kings

That Phyllis MadelineMorine Whose Birth is sought to be registered was

born at Avonport Kings County on October 20, 1922

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

School record and marriage extract

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