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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000291

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary LouiseCooke Sex Male

Date of Birth May 28, 1922 Place of Birth Reserve MinesCounty of Cape Breton

Name of Father Henry Cooke MAIDEN NAME of Mother Cecilia Desveaux

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

Residence of Father when child was born Reserve Mines, Cape Breton Present address of Father Reserve Mines, Cape Breton

Occupation of Father at Birth of child Miner Place of birth of Father Reserve Mines, Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant David G. Address of Applicant Jones Date Mira Road, RR #2, Sydney, Cape Breton

Relationship of Applicant to child 4 November 1962

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary LouiseCooke

Born at Reserve Mines in the County of Cape Breton

That Mary LouiseCooke Whose Birth is sought to be registered was

born at Reserve Mines Cape Breton County on May 28, 1922

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

I stood as Godfather at baptism on June 7, 1922.

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