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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91600719

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marie DorothyCorkum Sex Female

Date of Birth September 18, 1922 Place of Birth Upper BranchCounty of Lunenburg

Name of Father Earnel Ralph Corkum MAIDEN NAME of Mother Elda Eliza Meldrum

Residence of Father when child was born Upper Branch, Lunenburg Co., NS Present address of Father Conquerall Bank, Lunenburg Co., NS

Occupation of Father at Birth of child Mariner Place of birth of Father LaHave, Lunenburg Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ella Corkum Address of Applicant Conquerall Bank, Lunenburg Co., NS Date 11 December 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marie DorothyCorkum

Born at Upper Branch in the County of Lunenburg

That Marie DorothyCorkum Whose Birth is sought to be registered was

born at Upper Branch Lunenburg County on September 18, 1922

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

That I am the mother of Marie Dorothy Corkum

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