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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000712

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles RayBurt Sex

Date of Birth December 8, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father William Charles Burt MAIDEN NAME of Mother Josephine Clemens

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

Residence of Father when child was born Sydney Present address of Father Summerside, PEI

Occupation of Father at Birth of child Labourer Place of birth of Father Sea View, PEI

Race Name and present address of Physician in attendance at birth

Signature of Applicant Charles Ray Burt Address of Applicant Sea View, PEI Date December 2, 1974

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles RayBurt

Born at Sydney in the County of Cape Breton

That Charles RayBurt Whose Birth is sought to be registered was

born at Sydney Cape Breton County on December 8, 1920

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

Baptism record recorded at St. Mark's Rectory, Kensington, PEI which shows given names in reverse order.

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