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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000788

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles RobertMacIntosh Sex Male

Date of Birth October 10, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father John Murray MacIntosh MAIDEN NAME of Mother Bertha C. Dixon

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

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

Occupation of Father at Birth of child Policeman Place of birth of Father Pleasant Bay

Race Name and present address of Physician in attendance at birth

Signature of Applicant Charles Robert MacIntosh Address of Applicant Summerside, Prince Edward Island Date May 24, 1976

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That Charles RobertMacIntosh Whose Birth is sought to be registered was

born at Sydney Cape Breton County on October 10, 1920

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

The attached "Certificate of Baptism", issued at Sydney's St. James' Presbyterian Church on December 5, 1920. As a true and correct copy of the original Certificate and accurately states date of birth in the Province of Nova Scotia. -Beryle Allison MacIntosh

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