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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000234

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lloyd GeorgeGough Sex Male

Date of Birth May 12, 1921 Place of Birth TruroCounty of Colchester

Name of Father   MAIDEN NAME of Mother  

Residence of Father when child was born Present address of Father

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

Race Caucasian Name and present address of Physician in attendance at birth

Signature of Applicant Peter J. O'Hearn Address of Applicant 106 Roy Building, Halifax Date March 6, 1957

Relationship of Applicant to child none

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lloyd GeorgeGough

Born at Truro in the County of Colchester

That Lloyd GeorgeGough Whose Birth is sought to be registered was

born at Truro Colchester County on May 12, 1921

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

1. Records of Halifax Infants Home - copies attached 2. Statutory Declaration of Nicolas H. Gough attached 3. Information from Childrens Aid Society Records and Court Record of Adoption; copies filed with the Registrar General

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