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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000702

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Kenneth ArchebaldShano Sex Male

Date of Birth May 15, 1920 Place of Birth Glace BayCounty of Cape Breton

Name of Father Kenneth Shano MAIDEN NAME of Mother Mary Grace Hurley

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

Residence of Father when child was born Canada Present address of Father deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Kenneth A. Shano Address of Applicant Coburg, Ontario Date October 15, 1974

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Kenneth ArchebaldShano

Born at Glace Bay in the County of Cape Breton

That Kenneth ArchebaldShano Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on May 15, 1920

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

A Baptism Certificate acquired from St. John's Parish, Glace Bay

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