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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000429

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Hazel JuneHopkins Sex Female

Date of Birth June 28, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father   MAIDEN NAME of Mother Clara Hopkins

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant O.R. Hopkins Address of Applicant 777 Tower Rd. Halifax Date April 13, 1970

Relationship of Applicant to child Uncle

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Hazel JuneHopkins

Born at Halifax in the County of Halifax

That Hazel JuneHopkins Whose Birth is sought to be registered was

born at Halifax Halifax County on June 28, 1921

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

Baptismal certificate attached Certification from Dept of Public Welfare

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