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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000251

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 21, 1920 Place of Birth LourdesCounty of Pictou

Name of Father Thomas Scully MAIDEN NAME of Mother Sarah MacMillan

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

Residence of Father when child was born Lourdes, Pictou Co. Present address of Father deceased

Occupation of Father at Birth of child Mine Official Place of birth of Father Westville, Pictou Co.

Race Canadian Name and present address of Physician in attendance at birth Dr. Whitman, Stellarton

Signature of Applicant John I. Scully Address of Applicant Lourdes, Pictou Co. Date 21 March 1956

Relationship of Applicant to child Same

AFFIDAVIT

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

Born at Lourdes in the County of Pictou

That John IgnatiusScully Whose Birth is sought to be registered was

born at Lourdes Pictou County on January 21, 1920

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

I produce herewith certified copy of certificate of birth and baptism taken from the church records at Lourdes and signed by the Parish Priest, M. Gillis.

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