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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000358

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of SimonHart Sex Male

Date of Birth July 13, 1921 Place of Birth BridgeportCounty of Cape Breton

Name of Father Charles Hart MAIDEN NAME of Mother Annie Gardner

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

Residence of Father when child was born Bridgeport Present address of Father deceased

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

Race White Name and present address of Physician in attendance at birth Dr. J.B. Tompkins

Signature of Applicant Mary Ellen Lee Address of Applicant River Ryan Date September 6, 1966

Relationship of Applicant to child First cousin

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of SimonHart

Born at Bridgeport in the County of Cape Breton

That SimonHart Whose Birth is sought to be registered was

born at Bridgeport Cape Breton County on July 13, 1921

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

Simon Hart resided with my family for a period of time while while his mother was hospitalized. I know his date of birth and I further remember Simon Hart as an infant child when he lived at our home.

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