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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000974

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Water GilbertBlack Sex Male

Date of Birth July 28, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Angus Black MAIDEN NAME of Mother Mary Hayes

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 Brassfitter Place of birth of Father Marion Bridge

Race Name and present address of Physician in attendance at birth

Signature of Applicant Enid Black Address of Applicant Digby Date June 1, 1982

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Water GilbertBlack

Born at Sydney in the County of Cape Breton

That Water GilbertBlack Whose Birth is sought to be registered was

born at Sydney Cape Breton County on July 28, 1921

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

Baptismal Certificate

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