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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000709

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John ReginaldStagg Sex Male

Date of Birth September 14, 1921 Place of Birth North SydneyCounty of Cape Breton

Name of Father William J. Stagg MAIDEN NAME of Mother Mildred Davidge

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

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

Occupation of Father at Birth of child Miner Place of birth of Father Fortune Bay, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Mildred Stagg Address of Applicant Prince St. North Sydney Date July 25, 1977

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John ReginaldStagg

Born at North Sydney in the County of Cape Breton

That John ReginaldStagg Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on September 14, 1921

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

I am his mother - Baptism Certificate enclosed

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