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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700939

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Pauline GraceRipley Sex Female

Date of Birth June 22, 1923 Place of Birth River Philip CentreCounty of Cumberland

Name of Father Willard C. Ripley MAIDEN NAME of Mother Annie M. Colter

Residence of Father when child was born River Philip Centre, Cumberland Co., NS Present address of Father River Philip Centre, Cumberland Co., NS

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Willard Ripley Address of Applicant River Philip Centre, Cumberland Co., NS Date 7 September 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Pauline GraceRipley

Born at River Philip Centre in the County of Cumberland

That Pauline GraceRipley Whose Birth is sought to be registered was

born at River Philip Centre Cumberland County on June 22, 1923

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

I am her mother

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