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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600293

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Pierrette RoseTarse Sex Female

Date of Birth July 3, 1921 Place of Birth Reserve MinesCounty of Cape Breton

Name of Father Pietro Tarse MAIDEN NAME of Mother Mary Burnett

Residence of Father when child was born Reserve Mines, Cape Breton Co., NS Present address of Father Reserve Mines, Cape Breton Co., NS

Occupation of Father at Birth of child Place of birth of Father Italy

Race Name and present address of Physician in attendance at birth

Signature of Applicant Pietro Tarse Address of Applicant Reserve Mines, Cape Breton Co., NS Date

Relationship of Applicant to child 23 May 1935

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Pierrette RoseTarse

Born at Reserve Mines in the County of Cape Breton

That Pierrette RoseTarse Whose Birth is sought to be registered was

born at Reserve Mines Cape Breton County on July 3, 1921

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

Father and had above named child registered with Registrar.

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