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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000832

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Queenie IsabelGraham Sex Female

Date of Birth February 18, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father John Graham MAIDEN NAME of Mother Annie Gallop

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

Residence of Father when child was born 3 York St. Halifax Present address of Father 5548 Stairs Pl. Halifax

Occupation of Father at Birth of child C.N. driver Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Queenie Corkum Address of Applicant Pleasant Pt. Halifax Date May 29, 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Queenie IsabelGraham

Born at Halifax in the County of Halifax

That Queenie IsabelGraham Whose Birth is sought to be registered was

born at Halifax Halifax County on February 18, 1921

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

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