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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100174

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Leonard FieldingStephenson Sex Male

Date of Birth November 6, 1921 Place of Birth DominionCounty of Cape Breton

Name of Father Raymond Stephenson MAIDEN NAME of Mother Ethel Fielding

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

Residence of Father when child was born Dominion Present address of Father deceased

Occupation of Father at Birth of child Colliery Clerk Place of birth of Father Lingan

Race Name and present address of Physician in attendance at birth

Signature of Applicant Leonard F. Stephenson Address of Applicant 53 Commercial St. Dominion Date June 16, 1986

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Leonard FieldingStephenson

Born at Dominion in the County of Cape Breton

That Leonard FieldingStephenson Whose Birth is sought to be registered was

born at Dominion Cape Breton County on November 6, 1921

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

Certificate of Birth and Baptism from the records of Immaculate Conception Parish, Bridgeport, Dominion Personal knowledge passed on to me from my parents.

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