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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000734

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Eleanor RobertaGoudey Sex Female

Date of Birth October 15, 1921 Place of Birth Yarmouth HospitalCounty of Yarmouth

Name of Father William H. Goudey MAIDEN NAME of Mother Laura Graham

Residence of Father when child was born Port Maitland, Yarmouth Co., NS Present address of Father Port Maitland, Yarmouth Co., NS

Occupation of Father at Birth of child Farmer Place of birth of Father Cedar Lake, Yarmouth Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Laura Goudey Address of Applicant Port Maitland, Yarmouth Co., NS Date 17 March 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Eleanor RobertaGoudey

Born at Yarmouth Hospital in the County of Yarmouth

That Eleanor RobertaGoudey Whose Birth is sought to be registered was

born at Yarmouth Hospital Yarmouth County on October 15, 1921

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

That I am the mother of Eleanor Roberta Goudey

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