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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000042

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Maxwell AdamColes Sex Male

Date of Birth December 20, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Percy Pye Coles MAIDEN NAME of Mother Sophie Eliza Pike

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

Residence of Father when child was born Glace Bay Present address of Father deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Brooklyn, Newfoundland

Race English Name and present address of Physician in attendance at birth Dr. Fred Green

Signature of Applicant Lucy E. Blunden Address of Applicant 25 Pleasant St. Glace Bay Date October 8, 1947

Relationship of Applicant to child none

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Maxwell AdamColes

Born at Glace Bay in the County of Cape Breton

That Maxwell AdamColes Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 20, 1921

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

The record of Epworth Church which is attached here

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