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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000716

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of KathleenMcCormack Sex Female

Date of Birth November 25, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father Stephen McCormack MAIDEN NAME of Mother Annie McLellan

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

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

Occupation of Father at Birth of child Canadian National Railway Place of birth of Father French Road, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Stephen Nickelson Address of Applicant RR #5, Site 1, Compartment 5, Dutch Brook, Cape Breton Co., NS Date 8 March 1979

Relationship of Applicant to child Son

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of KathleenMcCormack

Born at Sydney in the County of Cape Breton

That KathleenMcCormack Whose Birth is sought to be registered was

born at Sydney Cape Breton County on November 25, 1923

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

Attached certificate of birth and baptism, Sacred Heart Parish, Sydney, NS

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