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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100070

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 3, 1922 Place of Birth Jordan FerryCounty of Shelburne

Name of Father Roland Locke MAIDEN NAME of Mother Laura MacLean

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

Residence of Father when child was born Jordan Ferry Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Jordan Bay

Race Name and present address of Physician in attendance at birth

Signature of Applicant Kathleen Kirkey Address of Applicant 1104 Daly Street, Cornwall, Stormont County, Ontario Date 20 March 1986

Relationship of Applicant to child Same

AFFIDAVIT

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

Born at Jordan Ferry in the County of Shelburne

That Kathleen AngelineLocke Whose Birth is sought to be registered was

born at Jordan Ferry Shelburne County on October 3, 1922

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

As told by my parents. Dr. L.P. Churchill, Shelburne, in attendance - Grandmother Mrs. Archibald MacLean. Her Sister Miss Gertrude Firth, Jordan Bay, Mrs. Howard Decker, Jordan Ferry, Mrs. Foster Miller family friend Jordan Ferry Shelburne

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