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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100102

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Leo JohnKennedy Sex Male

Date of Birth February 28, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Michael Kennedy MAIDEN NAME of Mother Clara Elizabeth Phaelen

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

Residence of Father when child was born Port Morien Present address of Father deceased

Occupation of Father at Birth of child Miner (coal) Place of birth of Father Main-a-Dieu

Race Name and present address of Physician in attendance at birth

Signature of Applicant Leo J. Kennedy Address of Applicant 103 Emerald St. New Waterford Date May 9, 1985

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Leo JohnKennedy

Born at Glace Bay in the County of Cape Breton

That Leo JohnKennedy Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on February 28, 1921

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

See my baptismal Certificate attached here. In addition, my Mother and Father told me I was born on the 28 Feb. 1921. I have used this date Feb 28, 1921 all my lifetime as the date of the birth and I swear to the truth of this affidavit as the date of my birth.

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