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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000409

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William EarlBurchell Sex Male

Date of Birth June 15, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Earnest William Burchell MAIDEN NAME of Mother Annie MacDonald

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

Residence of Father when child was born 677 Arthur St. Glace Bay Present address of Father 677 Arthur St. Glace Bay

Occupation of Father at Birth of child Head Fireman Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth Dr. McAskill

Signature of Applicant William E. Burchell Address of Applicant 1457 Bennard Rd. Windsor, Ontario Date May 22, 1969

Relationship of Applicant to child Brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William EarlBurchell

Born at Glace Bay in the County of Cape Breton

That William EarlBurchell Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on June 15, 1921

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

At which time I was ten year of age and have celebrated that date with him through the years

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