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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000741

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ruby TeresaFraser Sex Female

Date of Birth April 13, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Charles Fraser MAIDEN NAME of Mother Jennie Mortimer

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

Residence of Father when child was born Sydney Present address of Father Sydney

Occupation of Father at Birth of child Hotel Clerk Place of birth of Father Sydney

Race Name and present address of Physician in attendance at birth

Signature of Applicant Charles Fraser Address of Applicant 51 Falmouth St. Sydney Date March 21, 1978

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ruby TeresaFraser

Born at Sydney in the County of Cape Breton

That Ruby TeresaFraser Whose Birth is sought to be registered was

born at Sydney Cape Breton County on April 13, 1921

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

That we are the parents

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