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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000989

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 15, 1921 Place of Birth South HarbourCounty of Victoria

Name of Father Thomas Vincent Dixon MAIDEN NAME of Mother Margaret Ann Fitzgerald

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

Residence of Father when child was born South Harbour Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father South Harbour

Race Name and present address of Physician in attendance at birth

Signature of Applicant William Michael Dixon Address of Applicant 1155 Westmount Rd. Sydney Date September 28, 1982

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at South Harbour in the County of Victoria

That William MichaelDixon Whose Birth is sought to be registered was

born at South Harbour Victoria County on January 15, 1921

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

Church Baptism Records

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