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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000765

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Phyllis MarianBain Sex Female

Date of Birth August 13, 1923 Place of Birth Beaver RiverCounty of Yarmouth

Name of Father Eugene Landers Bain MAIDEN NAME of Mother Nellie A. Crosby

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

Residence of Father when child was born Beaver River Yarmouth Co. Ns Present address of Father RR #1, Yarmouth, NS

Occupation of Father at Birth of child Farmer Place of birth of Father Pembroke, Yarmouth Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Eugene L. Bain Address of Applicant RR #1, Yarmouth, NS Date 14 January 1980

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Phyllis MarianBain

Born at Beaver River in the County of Yarmouth

That Phyllis MarianBain Whose Birth is sought to be registered was

born at Beaver River Yarmouth County on August 13, 1923

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

Phyllis Marian Bain is my daughter

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