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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000791

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Shirley CarolineVanHorne Sex Female

Date of Birth February 14, 1922 Place of Birth YarmouthCounty of Yarmouth

Name of Father Harold VanHorne MAIDEN NAME of Mother Ruby Bethune

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

Residence of Father when child was born Yarmouth Present address of Father Nova Scotia

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant J. Mark McCrea Address of Applicant c/o Patterson, Smith, Matthews & Grant, PO Box 1068, Truro Date 21 January 1980

Relationship of Applicant to child None

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Shirley CarolineVanHorne

Born at Yarmouth in the County of Yarmouth

That Shirley CarolineVanHorne Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on February 14, 1922

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

Order of Judge R. F. MacLellan in and for the County court for District Number Four, Pursuant to an application under Section 7 of the Vital Statistics Act, as amended.

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