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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000998

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Raymond KitchenerO'Brien Sex Male

Date of Birth November 21, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father John O'Brien MAIDEN NAME of Mother Mary McIsaac

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

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

Occupation of Father at Birth of child Army service Place of birth of Father Prince Edward Island

Race Name and present address of Physician in attendance at birth

Signature of Applicant Raymond Kitchener O'Brien Address of Applicant Montreal Date June 13, 1979

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Raymond KitchenerO'Brien

Born at Halifax in the County of Halifax

That Raymond KitchenerO'Brien Whose Birth is sought to be registered was

born at Halifax Halifax County on November 21, 1920

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

Baptismal

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