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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000251

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jean TheresaRichard Sex Female

Date of Birth July 22, 1921 Place of Birth DartmouthCounty of Halifax

Name of Father Harry Bernard Richard MAIDEN NAME of Mother Jean  Tobin

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

Residence of Father when child was born 18 Rose St. Dartmouth Present address of Father 42 Shirley St. Halifax

Occupation of Father at Birth of child Garage Operator Place of birth of Father Dartmouth

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

Signature of Applicant Jean T. Richard Address of Applicant 42 Shirley St. Halifax Date January 16, 1958

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jean TheresaRichard

Born at Dartmouth in the County of Halifax

That Jean TheresaRichard Whose Birth is sought to be registered was

born at Dartmouth Halifax County on July 22, 1921

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

Baptism Certificate Marriage Record

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