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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000165

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John FrancisHarrietha Sex Male

Date of Birth April 24, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father Andrew Harrietha MAIDEN NAME of Mother Lucy Murphy

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

Residence of Father when child was born Glace Bay, Cape Breton Present address of Father Glace Bay, Cape Breton

Occupation of Father at Birth of child Miner Place of birth of Father Sydney Mines, Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Lucy Harrietha Address of Applicant Glace Bay, Cape Breton Date 8 July 1953

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John FrancisHarrietha

Born at Glace Bay in the County of Cape Breton

That John FrancisHarrietha Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on April 24, 1922

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

It is the date of birth set forth in the certificate of baptism dated May 22, 1922.

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