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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000990

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary KathleenHacquoil Sex Female

Date of Birth May 10, 1924 Place of Birth AmherstCounty of Cumberland

Name of Father Adolphus Francis Hacquoil MAIDEN NAME of Mother Mary O. Myers

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

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father Jersey Isle, England

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Adshade Address of Applicant Brantford, Ontario Date July 27, 2004

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary KathleenHacquoil

Born at Amherst in the County of Cumberland

That Mary KathleenHacquoil Whose Birth is sought to be registered was

born at Amherst Cumberland County on May 10, 1924

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

Certified Certificate of Birth and Baptism dated May 11, 1924 and certified Certificate of Marriage dated November 26, 1942.

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