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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000691

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Anita RoseMonk Sex Female

Date of Birth January 7, 1923 Place of Birth Ship HarbourCounty of Halifax

Name of Father Louis Monk MAIDEN NAME of Mother Robertina Murphy

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

Residence of Father when child was born Ship Harbour Halifax Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Ship Harbour, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Lorna L. Rafter Address of Applicant 1333 South Park Street, Apt. 919, Halifax, NS Date 26 January 1979

Relationship of Applicant to child Neice

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Anita RoseMonk

Born at Ship Harbour in the County of Halifax

That Anita RoseMonk Whose Birth is sought to be registered was

born at Ship Harbour Halifax County on January 7, 1923

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

I have the certificate of baptism.

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