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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100193

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Hazel EvangelineRichardson Sex Female

Date of Birth April 8, 1920 Place of Birth South BarCounty of Cape Breton

Name of Father Frederick Augustus  Richardson MAIDEN NAME of Mother Amelia Mary Stubbard

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

Residence of Father when child was born South Bar Present address of Father dead

Occupation of Father at Birth of child Farmer Place of birth of Father South Bar

Race Name and present address of Physician in attendance at birth

Signature of Applicant Hazel Birch Address of Applicant Sydney Forks Date December 17, 1982

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Hazel EvangelineRichardson

Born at South Bar in the County of Cape Breton

That Hazel EvangelineRichardson Whose Birth is sought to be registered was

born at South Bar Cape Breton County on April 8, 1920

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

Recorded in Family Bible

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