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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000030

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bernice OliveBlake Sex Female

Date of Birth September 7, 1924 Place of Birth YarmouthCounty of Yarmouth

Name of Father Melvin Blake MAIDEN NAME of Mother Fannie Allan

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

Residence of Father when child was born Stellarton, Pictou Co., NS Present address of Father Stellarton, Pictou Co., NS

Occupation of Father at Birth of child Miner Place of birth of Father Moncton, NB

Race Name and present address of Physician in attendance at birth

Signature of Applicant Fannie Ward Address of Applicant Yarmouth South, NS Date 11 February 1947

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bernice OliveBlake

Born at Yarmouth in the County of Yarmouth

That Bernice OliveBlake Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on September 7, 1924

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

I am the mother of the said Bernice Olive Blake

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