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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000593

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Laval BorromeoMountain Sex Male

Date of Birth November 2, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Henry Mountain MAIDEN NAME of Mother Mary Anne Wadden

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

Residence of Father when child was born Glace Bay Present address of Father Glace Bay

Occupation of Father at Birth of child Coal Miner Place of birth of Father Main-a-Dieu

Race Name and present address of Physician in attendance at birth

Signature of Applicant Laval Borromeo Mountain Address of Applicant 2 Sharon Crt. Brampton, Ontario Date July 22, 1975

Relationship of Applicant to child n/a - same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Laval BorromeoMountain

Born at Glace Bay in the County of Cape Breton

That Laval BorromeoMountain Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on November 2, 1921

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

1. The date of such birth is established by the notarial copy of my Baptismal Certificate, a copy of which is attached 2. The fact of such birth is established by the medical record of St. Josephs Hopital, the notarial copy of which is attached.

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