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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000101

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lois AlmedaRoss Sex Female

Date of Birth April 25, 1921 Place of Birth South Side Cape Sable IslandCounty of Shelburne

Name of Father Ira Newell Ross MAIDEN NAME of Mother Lula Ruth Nickerson

Residence of Father when child was born South Side Cape Sable Island, Shelburne Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Stoney Island, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Marsden K. Smith Address of Applicant South Side Cape Sable Island, Shelburne Co., NS Date 6 October 1941

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lois AlmedaRoss

Born at South Side Cape Sable Island in the County of Shelburne

That Lois AlmedaRoss Whose Birth is sought to be registered was

born at South Side Cape Sable Island Shelburne County on April 25, 1921

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

I am the mother of Lois Almeda Ross by former marriage

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