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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000453

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Daisy IscildaHenley Sex Female

Date of Birth January 19, 1922 Place of Birth ChelseaCounty of Lunenburg

Name of Father John William Henley MAIDEN NAME of Mother Bernice Sophia Joudrey

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

Residence of Father when child was born Chelsea, Lunenburg Present address of Father Chelsea, Lunenburg

Occupation of Father at Birth of child Meat Salesman Place of birth of Father Chelsea, Lunenburg

Race Name and present address of Physician in attendance at birth

Signature of Applicant Daisy Iscilda Cook Address of Applicant First South, Lunenburg Date 28 February 1972

Relationship of Applicant to child Same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Daisy IscildaHenley

Born at Chelsea in the County of Lunenburg

That Daisy IscildaHenley Whose Birth is sought to be registered was

born at Chelsea Lunenburg County on January 19, 1922

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

Marriage certificate, register from school records and census records.

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