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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000441

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Cleo ConstanceDavid Sex Female

Date of Birth June 4, 1922 Place of Birth HalifaxCounty of Halifax

Name of Father Jeremiah David MAIDEN NAME of Mother Matilda 

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

Residence of Father when child was born Hammonds Plains, Halifax Present address of Father Deceased

Occupation of Father at Birth of child Place of birth of Father Hammonds Plains, Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Neil H. Anderson Address of Applicant Hammonds Plains, Halifax Date 15 February 1972

Relationship of Applicant to child Friend

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Cleo ConstanceDavid

Born at Halifax in the County of Halifax

That Cleo ConstanceDavid Whose Birth is sought to be registered was

born at Halifax Halifax County on June 4, 1922

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

National Registration and Census.

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