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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000859

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 4, 1920 Place of Birth WoodsideCounty of Halifax

Name of Father   MAIDEN NAME of Mother Elsie Vance

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Kevin Burns Address of Applicant Halifax Date September 16, 1977

Relationship of Applicant to child none

AFFIDAVIT

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

Born at Woodside in the County of Halifax

That PercyVance Whose Birth is sought to be registered was

born at Woodside Halifax County on January 4, 1920

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

Attached records from Halifax Infants Home

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