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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000487

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marie AlvinaGould Sex Female

Date of Birth March 13, 1923 Place of Birth AmherstCounty of Cumberland

Name of Father   MAIDEN NAME of Mother Laura Gould

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Evelyn Morrell Address of Applicant 69 - 370 Pond Mills Road, London, Ontario Date 21 February 1974

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marie AlvinaGould

Born at Amherst in the County of Cumberland

That Marie AlvinaGould Whose Birth is sought to be registered was

born at Amherst Cumberland County on March 13, 1923

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

Certificate of birth and baptism certificate

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