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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000920

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jean AdelaideOlsen Sex Female

Date of Birth September 6, 1920 Place of Birth Cap La RondeCounty of Richmond

Name of Father Alfred John Angus Orson MAIDEN NAME of Mother Viola Adelaide Latimer

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

Residence of Father when child was born The Points, West Bay Present address of Father Melford

Occupation of Father at Birth of child Labourer Place of birth of Father The Points, West Bay

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jean Adelaide Amos Address of Applicant Ingonish Date July 14, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jean AdelaideOlsen

Born at Cap La Ronde in the County of Richmond

That Jean AdelaideOlsen Whose Birth is sought to be registered was

born at Cap La Ronde Richmond County on September 6, 1920

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

Baptismal Certificate - information taken from church records at St. John's Anglican Church in Arichat

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