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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700175

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Thomas AlexanderPendergrast Sex Male

Date of Birth December 9, 1919 Place of Birth Mill CreekCounty of Cape Breton

Name of Father Walter Pendergrast MAIDEN NAME of Mother Katherine Chisholme

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

Residence of Father when child was born Mill Creek Present address of Father

Occupation of Father at Birth of child Farmer Place of birth of Father Mill Creek

Race Name and present address of Physician in attendance at birth Dr. William T. McKeough

Signature of Applicant Walter Pendergrast Address of Applicant Mill Creek Date 12/1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Thomas AlexanderPendergrast

Born at Mill Creek in the County of Cape Breton

That Thomas AlexanderPendergrast Whose Birth is sought to be registered was

born at Mill Creek Cape Breton County on December 9, 1919

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

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