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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000407

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarence PatrickBurke Sex

Date of Birth January 2, 1920 Place of Birth North SydneyCounty of Cape Breton

Name of Father Patrick  Burke MAIDEN NAME of Mother Irene Bennet

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

Residence of Father when child was born North Sydney Present address of Father deceased

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

Race Anglo saxon Name and present address of Physician in attendance at birth Do no know.

Signature of Applicant Clarence Burke Address of Applicant R.R. 3, Brad d'Or Date January 11, 1965

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarence PatrickBurke

Born at North Sydney in the County of Cape Breton

That Clarence PatrickBurke Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on January 2, 1920

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

Attached Baptismal Certificate showing date of birth as January 2, 1920.

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