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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000962

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Kathleen EmmaSack Sex Female

Date of Birth March 30, 1922 Place of Birth ElmsdaleCounty of Hants

Name of Father Martin Sack MAIDEN NAME of Mother Mary Jane Jeremy

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

Residence of Father when child was born Elmsdale, Hants Present address of Father Deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Elmsdale, Hants

Race Name and present address of Physician in attendance at birth

Signature of Applicant Kathleen Eaton Address of Applicant PO Box 212, Whycocomagh, Inverness Date 6 February 1983

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Kathleen EmmaSack

Born at Elmsdale in the County of Hants

That Kathleen EmmaSack Whose Birth is sought to be registered was

born at Elmsdale Hants County on March 30, 1922

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

Baptism certificate

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