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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100092

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 15, 1923 Place of Birth Petit-de-GratCounty of Richmond

Name of Father Simon L. Landry MAIDEN NAME of Mother Bertha Samson

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

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father Petit-de-Grat

Race Name and present address of Physician in attendance at birth

Signature of Applicant Marie Madonne Landry Address of Applicant Samsons Cove Date March 10, 2005

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Petit-de-Grat in the County of Richmond

That Marie MadonneLandry Whose Birth is sought to be registered was

born at Petit-de-Grat Richmond County on June 15, 1923

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

Baptismal Certificate

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