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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000295

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 3, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father James Small MAIDEN NAME of Mother Mary Belle Sponagle

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

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

Occupation of Father at Birth of child Labourer Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary McCarthy Address of Applicant 119 Tupper Street, Sydney, Cape Breton Date 30 May 1963

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That Thomas WilliamSmall Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on May 3, 1922

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

I am his mother and the event is clear in my mind.

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