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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000584

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Inez MadelineMcCoombs Sex Female

Date of Birth February 3, 1922 Place of Birth MiltonCounty of Queens

Name of Father Oliver A. McCoombs MAIDEN NAME of Mother Winnie Maud Wamboldt

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

Residence of Father when child was born Milton, Queens Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Milton, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant Peggy Robar Address of Applicant 1 Renfrew Avenue, Apt. 8, Dartmouth Date 17 June 1976

Relationship of Applicant to child Daughter

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Inez MadelineMcCoombs

Born at Milton in the County of Queens

That Inez MadelineMcCoombs Whose Birth is sought to be registered was

born at Milton Queens County on February 3, 1922

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

National Registration Services and Census, Ottawa

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