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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000890

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 24, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father Albert Patrick von Syberg MAIDEN NAME of Mother Mary Elizabeth Bouchie

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

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

Occupation of Father at Birth of child Postal Clerk Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Carol von Syberg Address of Applicant Halifax Date March 3, 1978

Relationship of Applicant to child sister-in-law

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary AgnesVon Syberg

Born at Halifax in the County of Halifax

That Mary AgnesVon Syberg Whose Birth is sought to be registered was

born at Halifax Halifax County on December 24, 1920

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

Certificate of Baptism

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