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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000809

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Genevieve RoseBlack Sex Female

Date of Birth September 5, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Joseph Black MAIDEN NAME of Mother Mary Ann MacKillop

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 Labourer Place of birth of Father Grand Mira

Race Name and present address of Physician in attendance at birth

Signature of Applicant Genevieve Dalton Address of Applicant 138 Cabot St. Sydney Date March 19, 1979

Relationship of Applicant to child n/a

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Genevieve RoseBlack

Born at Sydney in the County of Cape Breton

That Genevieve RoseBlack Whose Birth is sought to be registered was

born at Sydney Cape Breton County on September 5, 1921

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

Certificate of Birth and Baptism Holy Redeemer Church Sydney dated Jan 14, 1972

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