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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000538

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Eileen RebeccaHazel Sex Female

Date of Birth February 17, 1921 Place of Birth Baxters HarbourCounty of Kings

Name of Father James Joshua Hazel MAIDEN NAME of Mother Ethel Rand

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Baxters Harbour Present address of Father deceased

Occupation of Father at Birth of child Mail Driver, Farmer Place of birth of Father Arlington

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

Signature of Applicant Eileen Rebecca Ellis Address of Applicant RR3 Canning Date January 14, 1974

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Eileen RebeccaHazel

Born at Baxters Harbour in the County of Kings

That Eileen RebeccaHazel Whose Birth is sought to be registered was

born at Baxters Harbour Kings County on February 17, 1921

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

Family Bible Record enclosed Census Record (Please forward from your search)

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