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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000170

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Myrtle VivianRose Sex Female

Date of Birth December 12, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Henry Miles Rose MAIDEN NAME of Mother Jane Farrell

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

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

Occupation of Father at Birth of child Carpenter Place of birth of Father Belleoram, Newfoundland

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

Signature of Applicant Jane Rose Address of Applicant Montreal, Quebec Date January 26, 1953

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Myrtle VivianRose

Born at Sydney in the County of Cape Breton

That Myrtle VivianRose Whose Birth is sought to be registered was

born at Sydney Cape Breton County on December 12, 1921

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

(See above) Relationship - Mother. (Baptism Records)

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