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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000944

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marie CarmelGallivan Sex Female

Date of Birth October 2, 1920 Place of Birth ReserveCounty of Cape Breton

Name of Father Joe Gallivan MAIDEN NAME of Mother Delphine Syms

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

Residence of Father when child was born Reserve Mines Present address of Father deceased

Occupation of Father at Birth of child Miner Place of birth of Father don't know

Race Name and present address of Physician in attendance at birth

Signature of Applicant Marie Carmel Gallivan Address of Applicant Reserve Mines Date October 7, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marie CarmelGallivan

Born at Reserve in the County of Cape Breton

That Marie CarmelGallivan Whose Birth is sought to be registered was

born at Reserve Cape Breton County on October 2, 1920

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

I have seen Marie Carmel Gallivan's Baptismal Certificate and believe it to be a true and correct recording of the above mentioned birth.

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