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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91703450

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Henry KennethBurgess Sex Male

Date of Birth June 21, 1920 Place of Birth DartmouthCounty of Halifax

Name of Father Henry K. Burgess MAIDEN NAME of Mother Edith Llewelyn Eynon

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

Residence of Father when child was born Truro, Colchester Co. Present address of Father Watertown, Massachusetts, USA

Occupation of Father at Birth of child Contractor Place of birth of Father Clifton, Colchester Co.

Race English Name and present address of Physician in attendance at birth

Signature of Applicant H. K. Burgess Address of Applicant 9 Winter Street, Watertown, Massachusetts, USA Date 2 June 1943

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Henry KennethBurgess

Born at Dartmouth in the County of Halifax

That Henry KennethBurgess Whose Birth is sought to be registered was

born at Dartmouth Halifax County on June 21, 1920

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

Being his father and being there when born. Also living at Truro after he was born.

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