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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000877

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Francis ReginaldBurgess Sex Male

Date of Birth November 9, 1920 Place of Birth AldershotCounty of Kings

Name of Father Arthur Vernon Burgess MAIDEN NAME of Mother Mable Marjorie Purcell

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

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

Occupation of Father at Birth of child Section Man on Railroad Place of birth of Father Greenwich

Race Name and present address of Physician in attendance at birth

Signature of Applicant Hazel M. Best Address of Applicant Waterville Date December 2, 1977

Relationship of Applicant to child none

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Francis ReginaldBurgess

Born at Aldershot in the County of Kings

That Francis ReginaldBurgess Whose Birth is sought to be registered was

born at Aldershot Kings County on November 9, 1920

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

1. School record enclosed 2. Statistics record enclosed

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