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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100380

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 13, 1920 Place of Birth Eastern PassageCounty of Halifax

Name of Father Maurice Henneberry MAIDEN NAME of Mother Rose Kelly

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

Residence of Father when child was born Eastern Passage Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Hazel Pepper Address of Applicant Hamilton, Ontario Date July 16, 1990

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Eastern Passage in the County of Halifax

That Hazel MaryHenneberry Whose Birth is sought to be registered was

born at Eastern Passage Halifax County on May 13, 1920

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

Born at home Marriage Extract Baptismal Certificate

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