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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700304

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Myrtle JeanStevens Sex Female

Date of Birth May 11, 1923 Place of Birth Wallace GrantCounty of Cumberland

Name of Father L. Gordon Stevens MAIDEN NAME of Mother Effie M. MacFarlane

Residence of Father when child was born Wallace Grant, Cumberland Co., NS Present address of Father Malagash Station, Cumberland Co., NS

Occupation of Father at Birth of child Farmer Place of birth of Father Wallace Grant, Cumberland Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Effie M. Stevens Address of Applicant Malagash Station, Cumberland Co., NS Date 14 July 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Myrtle JeanStevens

Born at Wallace Grant in the County of Cumberland

That Myrtle JeanStevens Whose Birth is sought to be registered was

born at Wallace Grant Cumberland County on May 11, 1923

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

That I am her mother

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