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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500049

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 14, 1919 Place of Birth River HebertCounty of Cumberland

Name of Father Willie P Burke MAIDEN NAME of Mother Maggie Burke

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

Residence of Father when child was born River Hebert Present address of Father

Occupation of Father at Birth of child Miner Place of birth of Father Cape Bald, NB

Race Name and present address of Physician in attendance at birth Dr. Rockwell

Signature of Applicant Willie P. Burke Address of Applicant River Hebert Date 24 December 1919

Relationship of Applicant to child father

AFFIDAVIT

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

Born at River Hebert in the County of Cumberland

That LeonBurke Whose Birth is sought to be registered was

born at River Hebert Cumberland County on October 14, 1919

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

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