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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100129

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of GladysClarke Sex Female

Date of Birth January 13, 1922 Place of Birth Birch GroveCounty of Cape Breton

Name of Father Josiah Clarke MAIDEN NAME of Mother Jane Hayward

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

Residence of Father when child was born Birch Grove, Cape Breton Present address of Father

Occupation of Father at Birth of child Place of birth of Father Carbonear, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Anne Clarke Address of Applicant 240 - 7001 Leppert Street, Halifax Date 22 November 1991

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of GladysClarke

Born at Birch Grove in the County of Cape Breton

That GladysClarke Whose Birth is sought to be registered was

born at Birch Grove Cape Breton County on January 13, 1922

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

Baptism, Barncroft Orphanage records.

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