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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600292

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Merle CarletonPineo Sex Male

Date of Birth July 23, 1921 Place of Birth WatervilleCounty of Kings

Name of Father Ralph LeRoy Pineo MAIDEN NAME of Mother Ada Pelton

Residence of Father when child was born Waterville, Kings Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Cooper Place of birth of Father New Minas, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ada Pineo Address of Applicant Waterville, Kings Co., NS Date 29 July 1935

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Merle CarletonPineo

Born at Waterville in the County of Kings

That Merle CarletonPineo Whose Birth is sought to be registered was

born at Waterville Kings County on July 23, 1921

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

I moved in the Pineo house and my baby was drowned in the brook that spring and my son was born two months after his death.

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