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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000791

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gwendolyn MaryKelly Sex Female

Date of Birth August 12, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father John Clifford Kelly MAIDEN NAME of Mother Wellelmina Walsh

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

Residence of Father when child was born Halifax Present address of Father deceased

Occupation of Father at Birth of child Halifax Fire Department Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gwendolyn Mary Hiet Address of Applicant 6429 Clanronald Ave. Montreal, Quebec Date February 8, 1979

Relationship of Applicant to child Same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gwendolyn MaryKelly

Born at Halifax in the County of Halifax

That Gwendolyn MaryKelly Whose Birth is sought to be registered was

born at Halifax Halifax County on August 12, 1921

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

Certification

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