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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000841

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Myrtle CavellHussey Sex Female

Date of Birth May 10, 1921 Place of Birth Whitney PierCounty of Cape Breton

Name of Father Uriah Hussey MAIDEN NAME of Mother Annie Mae Coombs

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

Residence of Father when child was born Whitney Pier Present address of Father deceased

Occupation of Father at Birth of child Steel Worker Place of birth of Father Upper Island Cove, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Myrtle Cavell Clarke Address of Applicant 2-2055 Ellesmere Rd. Marmora, Ontario Date March 6, 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Myrtle CavellHussey

Born at Whitney Pier in the County of Cape Breton

That Myrtle CavellHussey Whose Birth is sought to be registered was

born at Whitney Pier Cape Breton County on May 10, 1921

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

I am the brother of the said Myrtle Cavell Clarke (nee Hussey)

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