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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000971

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Francois BernardRomain Sex Male

Date of Birth February 28, 1922 Place of Birth MeteghanCounty of Digby

Name of Father George Zachary Romain MAIDEN NAME of Mother Elizabeth Ada Doucet

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

Residence of Father when child was born Meteghan, Digby Present address of Father 38 East Bowery Street, Newport, Rhode Island, USA

Occupation of Father at Birth of child Farmer Place of birth of Father Meteghan, Digby

Race Name and present address of Physician in attendance at birth

Signature of Applicant Francois Bernard Romain Address of Applicant PO Box 18665 Glendale, Arizona, 85311, USA Date 4 January 1984

Relationship of Applicant to child Myself and my sister Emma Edes

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Francois BernardRomain

Born at Meteghan in the County of Digby

That Francois BernardRomain Whose Birth is sought to be registered was

born at Meteghan Digby County on February 28, 1922

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

Francois was born at home. As his sister I was present in the home at the time of his birth.

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