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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100231

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John WilliamEverett Sex

Date of Birth May 25, 1920 Place of Birth North SydneyCounty of Cape Breton

Name of Father George William Everett MAIDEN NAME of Mother Maude Charlotte Andrews

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

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

Occupation of Father at Birth of child Telegraph Operator Place of birth of Father Moncton, New Brunswick

Race Name and present address of Physician in attendance at birth

Signature of Applicant John William Everett Address of Applicant Box 42, Cultus lake, British Columbia Date July 20, 1983

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John WilliamEverett

Born at North Sydney in the County of Cape Breton

That John WilliamEverett Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on May 25, 1920

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

My birth certificate has been lost and I am attempting to obtain another.

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