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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90700005

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jacqulin FrancesSteeves Sex Female

Date of Birth September 11, 1922 Place of Birth AmherstCounty of Cumberland

Name of Father Harry Clinton Steeves MAIDEN NAME of Mother margaret A. Muirhead

Residence of Father when child was born Amherst, Cumberland Co., NS Present address of Father Detroit, Michigan, USA

Occupation of Father at Birth of child Merchant Place of birth of Father Amherst, Cumberland Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Harry C. Steeves Address of Applicant 5832 Hazlett Street, Detroit, Michigan, USA Date 16 September 1937

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jacqulin FrancesSteeves

Born at Amherst in the County of Cumberland

That Jacqulin FrancesSteeves Whose Birth is sought to be registered was

born at Amherst Cumberland County on September 11, 1922

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

I am the father of Jacqulin Frances Steeves

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