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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000841

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Shirley BeatriceCorkum Sex Female

Date of Birth August 29, 1924 Place of Birth LunenburgCounty of Lunenburg

Name of Father Foster Arthur Corkum MAIDEN NAME of Mother Jennie Luetta Tanner

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

Residence of Father when child was born Lunenburg Present address of Father deceased

Occupation of Father at Birth of child Sea Captain Place of birth of Father Feltzen South

Race Name and present address of Physician in attendance at birth

Signature of Applicant Shirley B. Montgomery Address of Applicant 103 Herring Cove Rd. Armdale Date June 2, 1986

Relationship of Applicant to child Child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Shirley BeatriceCorkum

Born at Lunenburg in the County of Lunenburg

That Shirley BeatriceCorkum Whose Birth is sought to be registered was

born at Lunenburg Lunenburg County on August 29, 1924

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

(1) Baptism (2) Marriage Extract

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