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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000356

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of HaroldArchibald Sex Male

Date of Birth April 13, 1920 Place of Birth North SydneyCounty of Cape Breton

Name of Father Harold Albert Archibald MAIDEN NAME of Mother Florence Jane Keeping

Were the Parents married at the time of the Birth?

Residence of Father when child was born North Sydney, Cape Breton Co. Present address of Father deceased

Occupation of Father at Birth of child Taxi Driver Place of birth of Father Truro, Colchester Co.

Race Canadian Name and present address of Physician in attendance at birth Dan McDonald

Signature of Applicant Harold A. Archibald Address of Applicant 210 Ontario Street, Sarnia, Ontario Date 11 December 1961

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of HaroldArchibald

Born at North Sydney in the County of Cape Breton

That HaroldArchibald Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on April 13, 1920

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

I am the mother of the applicant and remember the date of birth. There was a life insurance policy taken out for him before he was two years of age, with the Metropolitan Life Insurance Company, through Clement Ings, Agent, sor the said Company at the time at North Sydney. the policy was cashed in but a record of same was sent about two years ago to the Department of Vital Statistics, Halifax. Having first been read over and explained to the said Florence Jane Archibald, who expressed herself as fully understanding the same, and signed the same by her mark.

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