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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000467

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Helen MargueriteCleveland Sex Female

Date of Birth May 21, 1922 Place of Birth YarmouthCounty of Yarmouth

Name of Father George Lent Cleveland MAIDEN NAME of Mother  Harris

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

Residence of Father when child was born Yarmouth Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father yarmouth

Race Name and present address of Physician in attendance at birth

Signature of Applicant Helen M. Harris Address of Applicant RR #3, Yarmouth Date 16 January 1973

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Helen MargueriteCleveland

Born at Yarmouth in the County of Yarmouth

That Helen MargueriteCleveland Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on May 21, 1922

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

Oldest sister and there at time of birth.

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