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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000265

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ethel LoisForsythe Sex Female

Date of Birth August 25, 1924 Place of Birth Port WilliamsCounty of Kings

Name of Father James Lovitt Forsythe MAIDEN NAME of Mother Dora Frances Chase

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

Residence of Father when child was born Port Williams, Kings Co., NS Present address of Father Deceassed

Occupation of Father at Birth of child Farmer Place of birth of Father Greenwich, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ellery R. Pineo Address of Applicant 74 Coronation Avenue, Fairview, Halifax Co., NS Date 10 February 1964

Relationship of Applicant to child Husband

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ethel LoisForsythe

Born at Port Williams in the County of Kings

That Ethel LoisForsythe Whose Birth is sought to be registered was

born at Port Williams Kings County on August 25, 1924

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

Bible record Census report Marriage record

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