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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000804

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Hazel Julia PriscillaTupper Sex Female

Date of Birth April 22, 1923 Place of Birth South East PassageCounty of Halifax

Name of Father Chester Alexander MAIDEN NAME of Mother Irma Mary Dunsworth

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

Residence of Father when child was born South East Passage Dartmouth Ns Present address of Father 8 Guysborough Avenue, Dartmouth, NS

Occupation of Father at Birth of child Farmer Place of birth of Father Stewiacke, Colchester Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Hazel J. P. Kellerman Address of Applicant 9 Weyburn Street, Dartmouth, NS Date 21 April 1981

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Hazel Julia PriscillaTupper

Born at South East Passage in the County of Halifax

That Hazel Julia PriscillaTupper Whose Birth is sought to be registered was

born at South East Passage Halifax County on April 22, 1923

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

Information passed on to me by my parents Baptism record

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