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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92800186

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mildred GladysFrancis Sex Female

Date of Birth January 28, 1920 Place of Birth PlymouthCounty of Pictou

Name of Father William Francis MAIDEN NAME of Mother Anna Marie Johnson

Residence of Father when child was born Plymouth, Pictou Co., NS Present address of Father Plymouth, Pictou Co., NS

Occupation of Father at Birth of child Car inspector, Canadian National Railway Place of birth of Father England

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. A. M. Francis Address of Applicant Plymouth Date June 16, 1944

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mildred GladysFrancis

Born at Plymouth in the County of Pictou

That Mildred GladysFrancis Whose Birth is sought to be registered was

born at Plymouth Pictou County on January 28, 1920

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

I am the Mother of Mildred Gladys Francis and well remember said date.

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