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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000732

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gerald FrederickMader Sex Male

Date of Birth May 21, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father Charles Mader MAIDEN NAME of Mother Elizabeth Jamieson

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

Residence of Father when child was born 200 Robie St. Halifax Present address of Father deceased

Occupation of Father at Birth of child Restaurant Owner Place of birth of Father Maders Cove

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gerald F. Mader Address of Applicant 6022 South St. Halifax Date February 22, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gerald FrederickMader

Born at Halifax in the County of Halifax

That Gerald FrederickMader Whose Birth is sought to be registered was

born at Halifax Halifax County on May 21, 1921

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

Baptismal Certificate Extract from marriage record - Birthplace

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