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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000461

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Theresa PhyllisLloyd Sex Female

Date of Birth September 21, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father John George Lloyd MAIDEN NAME of Mother Edith Williams

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 Place of birth of Father Wales

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

Signature of Applicant Theresa Phyllis Lloyd Address of Applicant 112 Strawberry Hill, Stamford, Connecticut, USA Date March 3, 1971

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Theresa PhyllisLloyd

Born at Sydney in the County of Cape Breton

That Theresa PhyllisLloyd Whose Birth is sought to be registered was

born at Sydney Cape Breton County on September 21, 1921

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

Certification of Baptism Census record

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