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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000590

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary TheresaDoucette Sex Female

Date of Birth April 23, 1924 Place of Birth MulgraveCounty of Guysborough

Name of Father   MAIDEN NAME of Mother Viola M. Doucette

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Viola Theriault Address of Applicant Port Hawkesbury, Inverness Co., NS Date 22 September 1978

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary TheresaDoucette

Born at Mulgrave in the County of Guysborough

That Mary TheresaDoucette Whose Birth is sought to be registered was

born at Mulgrave Guysborough County on April 23, 1924

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

When child was three weeks old, mother moved to Prince Edward Island to be with her family

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