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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000905

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of CassandraClarke Sex Female

Date of Birth October 23, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Herbert James Clarke MAIDEN NAME of Mother Flora Belle Butt

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Curling Bay of Islands, Newfoundland Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Curling Bay of Islands, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Cassandra Hoare Address of Applicant 98 Peter St. Renfrew, Ontario Date October 23, 1980

Relationship of Applicant to child Same Person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of CassandraClarke

Born at Sydney in the County of Cape Breton

That CassandraClarke Whose Birth is sought to be registered was

born at Sydney Cape Breton County on October 23, 1921

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

My true Parents were not married at that time. Were married on Dec 28th 1921. I was Baptised - Photostat copy enclosed - Baptised Cassandra Clarke

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