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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000433

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Catherine MedaClyburne Sex Female

Date of Birth March 25, 1923 Place of Birth StellartonCounty of Pictou

Name of Father Simon Clyburne MAIDEN NAME of Mother Emma May Myers

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

Residence of Father when child was born Stellarton Pictou Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Barber Place of birth of Father Isaac's Harbour, Guysborough Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Catherine Meda Hafey Address of Applicant Maple Street, Trenton, Pictou Co., NS Date 22 April 1972

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Catherine MedaClyburne

Born at Stellarton in the County of Pictou

That Catherine MedaClyburne Whose Birth is sought to be registered was

born at Stellarton Pictou County on March 25, 1923

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

Family record book - Church & School records

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