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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500334

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Helen Christena EdnaClark Sex Female

Date of Birth April 23, 1921 Place of Birth MeadowvilleCounty of Pictou

Name of Father James Fisker Clark MAIDEN NAME of Mother Ida Ann MacKenzie

Residence of Father when child was born Meadowville Present address of Father deceased

Occupation of Father at Birth of child Foreman and Railroad man Place of birth of Father Poplar Hill

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ida Ann MacKenzie Clark Address of Applicant Meadowville Date 28 October 1940

Relationship of Applicant to child The Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Helen Christena EdnaClark

Born at Meadowville in the County of Pictou

That Helen Christena EdnaClark Whose Birth is sought to be registered was

born at Meadowville Pictou County on April 23, 1921

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

I am the Mother of Helen Christina Edna Clark I have all the Births of my Children on Record in our family Bible and the facts stated above are true and correct

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