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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200042

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 9, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Edward Arthur Coolen MAIDEN NAME of Mother Annie Jane Littlejohn

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

Residence of Father when child was born Halifax Present address of Father 116 Quinpool Road

Occupation of Father at Birth of child Accountant Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth Dr. A. J. Mader

Signature of Applicant Edward Arthur Coolen Address of Applicant 116 Quinpool Road Date 10 November 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary AgathaCoolen

Born at Halifax in the County of Halifax

That Mary AgathaCoolen Whose Birth is sought to be registered was

born at Halifax Halifax County on October 9, 1919

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

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