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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000929

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Opal AmeliaBroome Sex Female

Date of Birth November 9, 1923 Place of Birth Central Port MoutonCounty of Queens

Name of Father Orlando Broome MAIDEN NAME of Mother  MacLeod

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

Residence of Father when child was born Port Mouton Queens Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Opal A. Bowers Address of Applicant RR #1, Port Mouton, Queens Co., NS Date 13 August 1984

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Opal AmeliaBroome

Born at Central Port Mouton in the County of Queens

That Opal AmeliaBroome Whose Birth is sought to be registered was

born at Central Port Mouton Queens County on November 9, 1923

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

Has lived in Port Mouton all her life.

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