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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000282

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Robert LeoWorks Sex Male

Date of Birth December 23, 1924 Place of Birth TruroCounty of Colchester

Name of Father Mack Blois Works MAIDEN NAME of Mother Jennie MacKenzie

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

Residence of Father when child was born Truro Heights, Colchester Co., NS Present address of Father Truro Heights, Colchester Co., NS

Occupation of Father at Birth of child Labourer Place of birth of Father Truro, Colchester Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Jennie Works Address of Applicant Truro Heights, Colchester Co., NS Date 6 May 1965

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Robert LeoWorks

Born at Truro in the County of Colchester

That Robert LeoWorks Whose Birth is sought to be registered was

born at Truro Colchester County on December 23, 1924

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

I am his mother

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