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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000818

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Evelyn MargaretKeough Sex Female

Date of Birth July 18, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Andrew Keough MAIDEN NAME of Mother Mary Ann MacRae

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 Pensioner - War Veteran Amputee Place of birth of Father Bonavista, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Evelyn M. Murphy Address of Applicant RR1 Sydney Forks Date March 29, 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Evelyn MargaretKeough

Born at Sydney in the County of Cape Breton

That Evelyn MargaretKeough Whose Birth is sought to be registered was

born at Sydney Cape Breton County on July 18, 1921

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

That I was advised by my parents that I was born on the 18th day of July, 1921 and throughout my lifetime I have celebrated the Anniversary of my birth on that date: Certificate of Baptism on record at Office of Registrar General, Halifax

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