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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000304

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Grace IsabellaSmith Sex Female

Date of Birth March 1, 1923 Place of Birth YarmouthCounty of Yarmouth

Name of Father Charles Edgar Smith MAIDEN NAME of Mother Mabel Berry

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Yarmouth Ns Present address of Father Yarmouth, NS

Occupation of Father at Birth of child Mill Hand Place of birth of Father Yarmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Grace Hearn Address of Applicant Salem, Yarmouth Co., NS Date 17 May 1965

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Grace IsabellaSmith

Born at Yarmouth in the County of Yarmouth

That Grace IsabellaSmith Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on March 1, 1923

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

Grace Isabelle Smith appears on Cradle roll Register as born on March 1, 1923. Abstract attached.

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