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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000104

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Thomas DonaldRose Sex Male

Date of Birth June 4, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Thomas Rose MAIDEN NAME of Mother Alice Hammond

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

Residence of Father when child was born Sydney, Cape Breton Present address of Father 253 St. Peters Road, Sydney, Cape Breton

Occupation of Father at Birth of child Railroad Man Place of birth of Father Fortune Bay, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant T. D. Rose Address of Applicant 211 Cottage Road, Sydney, Cape Breton Date 17 July 1950

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Thomas DonaldRose

Born at Sydney in the County of Cape Breton

That Thomas DonaldRose Whose Birth is sought to be registered was

born at Sydney Cape Breton County on June 4, 1922

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

Physician at birth (certificate of birth & baptism from church records attached)

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