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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000422

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 5, 1920 Place of Birth Pleasant LakeCounty of Yarmouth

Name of Father   MAIDEN NAME of Mother Cara Brooks Jeffery

Were the Parents married at the time of the Birth? No

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

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

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

Signature of Applicant Kathleen H. Woodruff Address of Applicant Yarmouth Date January 21, 1966

Relationship of Applicant to child same

AFFIDAVIT

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

Born at Pleasant Lake in the County of Yarmouth

That Kathleen HeatherJeffery Whose Birth is sought to be registered was

born at Pleasant Lake Yarmouth County on April 5, 1920

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

Abstract as taken from the Pleasant Lake School Register shows age as 7 Years, 2 Months, 26 days. An abstract from Dominion Bureau of Statistics shows date and place of birth as April 5, 1920, Pleasant Lake

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