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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000689

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Harvey RoyStay Sex Male

Date of Birth April 2, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father George Henry Stay MAIDEN NAME of Mother Elizabeth Luke

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

Residence of Father when child was born 55 Seymor St. Halifax Present address of Father deceased

Occupation of Father at Birth of child Shipper Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Harvey Stay Address of Applicant 6388 Liverpool St. Halifax Date June 21, 1977

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Harvey RoyStay

Born at Halifax in the County of Halifax

That Harvey RoyStay Whose Birth is sought to be registered was

born at Halifax Halifax County on April 2, 1921

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

Baptismal certificate Extract form marriage record - Birthplace

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