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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100275

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Etta EvelynJollimore Sex Female

Date of Birth January 6, 1920 Place of Birth Terence BayCounty of Halifax

Name of Father Hezron Jollimore MAIDEN NAME of Mother Ida Slaunwhite

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

Residence of Father when child was born Sandy Cove, Hfx Co. Present address of Father deceased

Occupation of Father at Birth of child fisiherman Place of birth of Father Terrence Bay

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sandi Ryan Address of Applicant RR#1 Armdale Date Aug. 7, 1984

Relationship of Applicant to child friend

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Etta EvelynJollimore

Born at Terence Bay in the County of Halifax

That Etta EvelynJollimore Whose Birth is sought to be registered was

born at Terence Bay Halifax County on January 6, 1920

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

baptismal

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