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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91400015

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bernice MaryAmero Sex Female

Date of Birth July 23, 1921 Place of Birth YarmouthCounty of Yarmouth

Name of Father Sylvain Amero MAIDEN NAME of Mother Katherine Robicheau

Residence of Father when child was born Gloucester, Massachusetts, USA Present address of Father Gloucester, Massachusetts, USA

Occupation of Father at Birth of child Fisherman Place of birth of Father Amirault's Hill, Yarmouth Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant William Robicheau Address of Applicant Yarmouth South, Yarmouth Co., NS Date 7 August 1941

Relationship of Applicant to child Grandfather

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bernice MaryAmero

Born at Yarmouth in the County of Yarmouth

That Bernice MaryAmero Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on July 23, 1921

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

I am the grandfather of the said Bernice Mary Amero and recall the date and place of her birth

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