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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000566

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jean BairdHorner Sex Female

Date of Birth August 5, 1923 Place of Birth Port MorienCounty of Cape Breton

Name of Father Ralph Russell Horner MAIDEN NAME of Mother Margery Olive Borden Baird

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

Residence of Father when child was born Port Morien Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Bank Manager Place of birth of Father Yarmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jean B. Lake Address of Applicant 3710 Glenview Crescent North, Vancouver, British Columbia Date 27 May 1976

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jean BairdHorner

Born at Port Morien in the County of Cape Breton

That Jean BairdHorner Whose Birth is sought to be registered was

born at Port Morien Cape Breton County on August 5, 1923

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

Baptismal certificate attached

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