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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000571

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mable RipleyNickerson Sex Female

Date of Birth August 13, 1923 Place of Birth Stony IslandCounty of Shelburne

Name of Father Adelbert Alliston Nickerson MAIDEN NAME of Mother Viola Gertrude Atkinson

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

Residence of Father when child was born Stony Island Shelburne Co. Ns Present address of Father Diseased

Occupation of Father at Birth of child Fisherman Place of birth of Father Stony Island, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Margaret L. Smith Address of Applicant Clarks Harbour, Shelburne Co., NS Date 9 March 1976

Relationship of Applicant to child Elder sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mable RipleyNickerson

Born at Stony Island in the County of Shelburne

That Mable RipleyNickerson Whose Birth is sought to be registered was

born at Stony Island Shelburne County on August 13, 1923

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

I can remember my age at the time my sister was born.

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