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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000294

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Cyril EdwardHenneberry Sex Male

Date of Birth May 20, 1922 Place of Birth SambroCounty of Halifax

Name of Father Augustus Henneberry MAIDEN NAME of Mother Helena Twohig

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

Residence of Father when child was born Sambro, Halifax Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Sambro, Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant C. E. Henneberry Address of Applicant Sambro, Halifax Date 30 April 1963

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Cyril EdwardHenneberry

Born at Sambro in the County of Halifax

That Cyril EdwardHenneberry Whose Birth is sought to be registered was

born at Sambro Halifax County on May 20, 1922

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

Certificate of birth as issued by St. Peters Church, Ketch Harbour, Halifax

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