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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000322

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 24, 1920 Place of Birth ArlingtonCounty of Kings

Name of Father Dennis Hazel MAIDEN NAME of Mother Edith Bennett

Were the Parents married at the time of the Birth?

Residence of Father when child was born Present address of Father

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

Race English Name and present address of Physician in attendance at birth

Signature of Applicant Mary E. Hazel Address of Applicant 150 Octerloney Street, Dartmouth Date 9 December 1958

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Arlington in the County of Kings

That Mary ElizabethHazel Whose Birth is sought to be registered was

born at Arlington Kings County on May 24, 1920

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

Information received as a young child and from Children's Aid Society and public school records. the surname Hazel has been used as long as I can remember and my mother was known as Mrs. Edith Hazel. (Based on Court order)

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