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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700502

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Harold RoyRoss Sex Male

Date of Birth October 4, 1919 Place of Birth Glace BayCounty of Cape Breton

Name of Father Rupert Ross MAIDEN NAME of Mother Annie Laurie Chen

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

Residence of Father when child was born Glace Bay Present address of Father Table Head

Occupation of Father at Birth of child Miner Place of birth of Father Margaree

Race Name and present address of Physician in attendance at birth F.W. Green

Signature of Applicant Annie Laurie Ross Address of Applicant Table Head, Glace Bay Date 31 October 1919

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Harold RoyRoss

Born at Glace Bay in the County of Cape Breton

That Harold RoyRoss Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on October 4, 1919

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

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