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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000050

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Wava HazelHaverstock Sex Female

Date of Birth November 16, 1921 Place of Birth Hammonds PlainsCounty of Halifax

Name of Father Maurice Amos Haverstock MAIDEN NAME of Mother Gladys Dorothy Hartlen

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

Residence of Father when child was born Hammond Plains Present address of Father Hammonds Plains

Occupation of Father at Birth of child Lumberman Place of birth of Father Hammonds Plains

Race English Name and present address of Physician in attendance at birth Mrs. R. Carleton

Signature of Applicant Gladys Haverstock Address of Applicant Hammonds Plains Date February 25, 1946

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Wava HazelHaverstock

Born at Hammonds Plains in the County of Halifax

That Wava HazelHaverstock Whose Birth is sought to be registered was

born at Hammonds Plains Halifax County on November 16, 1921

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

That I am the mother of Wava Hazel Haverstock and that she was born on November 16, 1921 at Hammonds Plains N.S.

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