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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000674

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth August 31, 1923 Place of Birth YarmouthCounty of Yarmouth

Name of Father Bernard Thomas Grace MAIDEN NAME of Mother Marie Elizabeth Nickerson

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

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

Occupation of Father at Birth of child Landscaper & Gardener Place of birth of Father Yarmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mildred Gertrude Cox Address of Applicant 23 Weyburn Road, Dartmouth, NS Date 26 September 1978

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Yarmouth in the County of Yarmouth

That Mildred GertrudeGrace Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on August 31, 1923

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

Extract from marriage record Canada census

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