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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000197

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Theresa HelenaRose Sex Female

Date of Birth April 6, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Henry Miles Rose MAIDEN NAME of Mother Jane Farrell

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

Residence of Father when child was born Sydney Present address of Father deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Belleoram, Newfoundland

Race English Name and present address of Physician in attendance at birth Dr. Currie (deceased)

Signature of Applicant Jane Rose Address of Applicant Montreal, Quebec Date January 26, 1920

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Theresa HelenaRose

Born at Sydney in the County of Cape Breton

That Theresa HelenaRose Whose Birth is sought to be registered was

born at Sydney Cape Breton County on April 6, 1920

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

(see above) - Relationship - Mother (Census report, school record, & Baptism certificate)

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