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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000039

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Kathleen JessieFader Sex Female

Date of Birth August 28, 1920 Place of Birth South Side Cape Sable IslandCounty of Shelburne

Name of Father George William Fader MAIDEN NAME of Mother Myrtle Nickerson

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

Residence of Father when child was born Halifax Present address of Father Miami, Florida

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

Race English Name and present address of Physician in attendance at birth Dr. George Brown, deceased

Signature of Applicant Waitie Nickerson Address of Applicant 85 Inglis St. Halifax Date May 7, 1947

Relationship of Applicant to child Grandmother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Kathleen JessieFader

Born at South Side Cape Sable Island in the County of Shelburne

That Kathleen JessieFader Whose Birth is sought to be registered was

born at South Side Cape Sable Island Shelburne County on August 28, 1920

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

Kathleen Jessie Fader was born in my home at South Side on August 28, 1920 and I was present at her birth

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