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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000787

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ada KathleenCoombs Sex Female

Date of Birth August 6, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Herbert Coombs MAIDEN NAME of Mother Ann Kelland

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 steel worker Place of birth of Father Bonavista, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Ada Keller Address of Applicant 23 Frederick St. Sydney Date November 18, 1978

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ada KathleenCoombs

Born at Sydney in the County of Cape Breton

That Ada KathleenCoombs Whose Birth is sought to be registered was

born at Sydney Cape Breton County on August 6, 1921

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

This is my own birth.

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