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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900390

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Muriel BeulahNickerson Sex Female

Date of Birth June 21, 1922 Place of Birth North East PointCounty of Shelburne

Name of Father Lewis Avery Nickerson MAIDEN NAME of Mother Ida Edith Crowell

Residence of Father when child was born North East Point, Shelburne Co., NS Present address of Father North East Point, Shelburne Co., NS

Occupation of Father at Birth of child Fisherman Place of birth of Father Clam Point, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Lewis A. Nickerson Address of Applicant North East Point, Shelburne Co., NS Date 15 January 1945

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Muriel BeulahNickerson

Born at North East Point in the County of Shelburne

That Muriel BeulahNickerson Whose Birth is sought to be registered was

born at North East Point Shelburne County on June 21, 1922

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

I am the father of Muriel Beulah Nickerson

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