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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100235

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Beverly DaneBaily Sex Male

Date of Birth May 22, 1921 Place of Birth DartmouthCounty of Halifax

Name of Father Henry Ernest Baily MAIDEN NAME of Mother May Georgena Martin

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

Residence of Father when child was born Dartmouth Present address of Father

Occupation of Father at Birth of child Place of birth of Father Montreal, Quebec

Race Name and present address of Physician in attendance at birth

Signature of Applicant Beverly Dane Baily Address of Applicant 11 Sugar Hill, Ville de Lac Brome, Quebec Date 21 June 2002

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Beverly DaneBaily

Born at Dartmouth in the County of Halifax

That Beverly DaneBaily Whose Birth is sought to be registered was

born at Dartmouth Halifax County on May 22, 1921

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

Letters and a certificate of Baptism from the Church of St. James, Dartmouth, NS

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