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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000098

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John MurrayKaulback Sex Male

Date of Birth December 12, 1923 Place of Birth Montague Mines, Halifax Co., NSCounty of Halifax

Name of Father George Lewis Kaulback MAIDEN NAME of Mother Alice Clearie Vaughan

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

Residence of Father when child was born Montague Mines Halifax Co. Ns Present address of Father Montague Mines, Halifax Co., NS

Occupation of Father at Birth of child Miner Place of birth of Father Middle Musquodoboit, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. George Kaulback Address of Applicant Montague Mines, Halifax Co., NS Date 14 March 1949

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John MurrayKaulback

Born at Montague Mines, Halifax Co., NS in the County of Halifax

That John MurrayKaulback Whose Birth is sought to be registered was

born at Montague Mines, Halifax Co., NS Halifax County on December 12, 1923

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

I am the mother of John Murray Kaulback. Certificate from School records attached.

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