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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000492

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Goldburne AlexanderSheppard Sex Male

Date of Birth October 28, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Charles Sheppard MAIDEN NAME of Mother Mytle Paris

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

Residence of Father when child was born Currys Lane, Sydney Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father New Glasgow

Race Black Name and present address of Physician in attendance at birth Mid-wife Mrs. Rachel Barnes

Signature of Applicant J. Horton Murray Address of Applicant 201 Mt. Pleasant St. Sydney Date April 24, 1972

Relationship of Applicant to child God-Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Goldburne AlexanderSheppard

Born at Sydney in the County of Cape Breton

That Goldburne AlexanderSheppard Whose Birth is sought to be registered was

born at Sydney Cape Breton County on October 28, 1921

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

Being the god-father of Goldburne Alexander Sheppard, and a personal friend of the late Charles Sheppard, his father, and living together, I have full knowledge of the Birth, and that the said child was born Oct. 28th 1921

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