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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000308

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Leroy JosephO'Brien Sex Male

Date of Birth June 8, 1922 Place of Birth DingwallCounty of Victoria

Name of Father Joseph O'Brien MAIDEN NAME of Mother Jessie Williams

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

Residence of Father when child was born Dingwall, Victoria Present address of Father Deceased

Occupation of Father at Birth of child General Dealer Place of birth of Father Bay Bulls, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Leroy J. O'Brien Address of Applicant 278 Water Street Date 9 March 1964

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Leroy JosephO'Brien

Born at Dingwall in the County of Victoria

That Leroy JosephO'Brien Whose Birth is sought to be registered was

born at Dingwall Victoria County on June 8, 1922

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

Found on leaf of family bible

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