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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000157

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Myrtle GertrudeStates Sex Female

Date of Birth November 23, 1924 Place of Birth Five Mile PlainsCounty of Hants

Name of Father George Fletcher States MAIDEN NAME of Mother Isabelle Upshaw

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

Residence of Father when child was born Five Mile Plains, Hants Co., NS Present address of Father Five Mile Plains, Hants Co., NS

Occupation of Father at Birth of child Quarryman Place of birth of Father Five Mile Plains, Hants Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Isabelle States Address of Applicant Five Mile Plains, Hants Co., NS Date 12 May 1955

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Myrtle GertrudeStates

Born at Five Mile Plains in the County of Hants

That Myrtle GertrudeStates Whose Birth is sought to be registered was

born at Five Mile Plains Hants County on November 23, 1924

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

I am the mother of the said child and I sent her to school at the age of 5 years and I kept a record of the births, deaths and marriages of my family

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