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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000676

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marion ShirleyEmbree Sex Female

Date of Birth October 5, 1924 Place of Birth Port HawkesburyCounty of Inverness

Name of Father Robert L. Embree MAIDEN NAME of Mother Catherine M. Hennessey

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

Residence of Father when child was born Port Hawkesbury, Inverness Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Canadian National Railway Employee Place of birth of Father Sunnyside, Richmond Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Marion S. Langley Address of Applicant Port Hawkesbury, Inverness Co., NS Date 2 July 1980

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marion ShirleyEmbree

Born at Port Hawkesbury in the County of Inverness

That Marion ShirleyEmbree Whose Birth is sought to be registered was

born at Port Hawkesbury Inverness County on October 5, 1924

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

Baptism certificate of United Church of Canada by Rev. R.L. Roach, dated November 19, 1926

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