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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500128

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of KattieHaley Sex Female

Date of Birth November 3, 1919 Place of Birth Wallace BridgeCounty of Cumberland

Name of Father John Haley MAIDEN NAME of Mother Hazel Ferdinand

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

Residence of Father when child was born Wallace Bridge Present address of Father

Occupation of Father at Birth of child Labourer Place of birth of Father Truro

Race Name and present address of Physician in attendance at birth Dr. Goodwin

Signature of Applicant John Haley Address of Applicant Wallace Bay Date 10 November 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of KattieHaley

Born at Wallace Bridge in the County of Cumberland

That KattieHaley Whose Birth is sought to be registered was

born at Wallace Bridge Cumberland County on November 3, 1919

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

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