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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000346

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarence Joseph AnthonyO'Brien Sex

Date of Birth March 10, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father   MAIDEN NAME of Mother Margaret O'Brien

Were the Parents married at the time of the Birth?

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father

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

Signature of Applicant Joseph A. O'Brien Address of Applicant Halifax Date June 5, 1961

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarence Joseph AnthonyO'Brien

Born at Halifax in the County of Halifax

That Clarence Joseph AnthonyO'Brien Whose Birth is sought to be registered was

born at Halifax Halifax County on March 10, 1920

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

Certificate of Baptism from St. Patrick's Church.

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