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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000120

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Irene MayClarke Sex Female

Date of Birth May 18, 1920 Place of Birth Glace BayCounty of Cape Breton

Name of Father Carmenus Clarke MAIDEN NAME of Mother Emily Elizabeth Mason

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

Residence of Father when child was born Port Morian Present address of Father Dead

Occupation of Father at Birth of child Miner Place of birth of Father Victoria, Newfoundland

Race White Name and present address of Physician in attendance at birth not known

Signature of Applicant J.M. Churchman Address of Applicant 3 Lee Park Blackhealth London S E 3 Date May 8, 1949

Relationship of Applicant to child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Irene MayClarke

Born at Glace Bay in the County of Cape Breton

That Irene MayClarke Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on May 18, 1920

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

Emily Elizabeth Clarke -- I am her mother. Certificate from church record.

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