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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000389

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John GeraldCooper Sex Male

Date of Birth November 4, 1921 Place of Birth DartmouthCounty of Halifax

Name of Father Frederick Evan Cooper MAIDEN NAME of Mother Isabelle Pettipas

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

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

Occupation of Father at Birth of child Farmer Place of birth of Father Montague Mines

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

Signature of Applicant Mrs. Gerald Cooper Address of Applicant Montague Mines Date September 4, 1968

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John GeraldCooper

Born at Dartmouth in the County of Halifax

That John GeraldCooper Whose Birth is sought to be registered was

born at Dartmouth Halifax County on November 4, 1921

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

Baptismal Certificate Extract from marriage record

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