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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000433

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roderick FrancisDevison Sex Male

Date of Birth October 11, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Roderick Russell Devison MAIDEN NAME of Mother Violet Moore

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 Miner Place of birth of Father Glace Bay

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

Signature of Applicant Roderick Francis Devison Address of Applicant 580 Howe St. Glace Bay Date April 30, 1970

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roderick FrancisDevison

Born at Glace Bay in the County of Cape Breton

That Roderick FrancisDevison Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on October 11, 1921

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

It is the date shown on the attached certificate particulars on which have been taken from the records at St. Johns Church. It is also the date shown on the certified Extract from the Family Bible record attached herewith.

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