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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000658

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 11, 1921 Place of Birth Scots Bay RoadCounty of Kings

Name of Father Lawson Alfred Brewster MAIDEN NAME of Mother Inez Barkhouse

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

Residence of Father when child was born Scots Bay Rd. Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Scots Bay Rd.

Race Name and present address of Physician in attendance at birth

Signature of Applicant Eileen Rhodes Address of Applicant Port Williams Date September 1976

Relationship of Applicant to child Same

AFFIDAVIT

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

Born at Scots Bay Road in the County of Kings

That Eileen PearlBrewster Whose Birth is sought to be registered was

born at Scots Bay Road Kings County on September 11, 1921

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

Marriage License #63361 signed September 1, 1942 (Please check your record) Census Record Please send form for search (No other given information)

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