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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000260

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Evelyn MargaretCorkum Sex Female

Date of Birth June 22, 1921 Place of Birth Conquerall BankCounty of Lunenburg

Name of Father Stephen March Corkum MAIDEN NAME of Mother Dorothy Helen Manthorne

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

Residence of Father when child was born Conquerall Bank Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Conquerall Bank

Race Canadian Name and present address of Physician in attendance at birth Dr. Frank Davis

Signature of Applicant Mrs. Evelyn Dorey Address of Applicant RCAF Station Camp Borden, Ontario Date August 29, 1958

Relationship of Applicant to child Applying in person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Evelyn MargaretCorkum

Born at Conquerall Bank in the County of Lunenburg

That Evelyn MargaretCorkum Whose Birth is sought to be registered was

born at Conquerall Bank Lunenburg County on June 22, 1921

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

On the Certificate of Baptism and the Certificate of the School Clerks taken from the Conquerall Bank School Register both attached hereto

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