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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000360

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ethel HelenaGrant Sex Female

Date of Birth October 25, 1923 Place of Birth Annapolis RoyalCounty of Annapolis

Name of Father Fred Alexander Grant MAIDEN NAME of Mother Pearl Gould

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

Residence of Father when child was born Halifax Ns Present address of Father Deceased

Occupation of Father at Birth of child Dairy Business Place of birth of Father Halifax, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant H. M. Grant Address of Applicant 124 Russell Avenue, Annapolis Royal, NS Date 25 July 1919

Relationship of Applicant to child Uncle

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ethel HelenaGrant

Born at Annapolis Royal in the County of Annapolis

That Ethel HelenaGrant Whose Birth is sought to be registered was

born at Annapolis Royal Annapolis County on October 25, 1923

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

I am her uncle

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