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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000451

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary EllenRoach Sex Female

Date of Birth November 23, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Patrick Roach MAIDEN NAME of Mother Julia Gallivan

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

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

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

Race Caucasian Name and present address of Physician in attendance at birth Dr. M.T. Sullivan

Signature of Applicant Mary E. Roach Address of Applicant 47 George St. New Waterford Date January 25, 1971

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary EllenRoach

Born at Glace Bay in the County of Cape Breton

That Mary EllenRoach Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on November 23, 1921

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

Baptismal Certificate, School Records, Hospital Records (documents enclosed)

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