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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000265

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Frederick LeoGorman Sex Male

Date of Birth April 23, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father   MAIDEN NAME of Mother Gertrude Cruise

Residence of Father when child was born Present address of Father

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

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

Signature of Applicant Monica Gorman Address of Applicant Herring Cove Date November 24, 1958

Relationship of Applicant to child Adoptive Parents

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Frederick LeoGorman

Born at Halifax in the County of Halifax

That Frederick LeoGorman Whose Birth is sought to be registered was

born at Halifax Halifax County on April 23, 1921

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

I am his adoptive mother Baptism Certificate

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