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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000054

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jennie GraceLively Sex Female

Date of Birth June 4, 1921 Place of Birth BeaverbankCounty of Halifax

Name of Father Martin Lively MAIDEN NAME of Mother Kathleen VanBuskirk

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

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

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

Race Canadian Name and present address of Physician in attendance at birth deceased

Signature of Applicant M.H. Lively Address of Applicant Sackville Date August 4, 1947

Relationship of Applicant to child Brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jennie GraceLively

Born at Beaverbank in the County of Halifax

That Jennie GraceLively Whose Birth is sought to be registered was

born at Beaverbank Halifax County on June 4, 1921

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

I am her senior brother by 14 years I was home at the time of her birth.

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