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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000675

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 27, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father William Gallivan MAIDEN NAME of Mother Cleophas MacGillivary

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

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

Occupation of Father at Birth of child Steel worker Place of birth of Father Sydney

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

Signature of Applicant William Leo Gallivan Address of Applicant 148 Shore Road, Sydney Date September 30, 1976

Relationship of Applicant to child applicant seeks to register his own birth

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That William LeoGallivan Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 27, 1921

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

1) Information from my parents 2) The attached birth certificate

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