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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000210

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John AnthonyLeBlanc Sex Male

Date of Birth May 4, 1920 Place of Birth JogginsCounty of Cumberland

Name of Father Charles J.  LeBlanc MAIDEN NAME of Mother Ella Burke

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

Residence of Father when child was born Joggins Present address of Father Joggins

Occupation of Father at Birth of child Miner Place of birth of Father Dupuis Corner, N.B.

Race Canadian Name and present address of Physician in attendance at birth Dr. U.M. Rockwell

Signature of Applicant Charles L. LeBlanc Address of Applicant Joggins Date November 12, 1953

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John AnthonyLeBlanc

Born at Joggins in the County of Cumberland

That John AnthonyLeBlanc Whose Birth is sought to be registered was

born at Joggins Cumberland County on May 4, 1920

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

That I am the father of the child mentioned and remember the circumstances. The Certificate of Baptism is enclosed

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