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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000352

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of PercyBrown Sex Male

Date of Birth March 29, 1922 Place of Birth North SydneyCounty of Cape Breton

Name of Father Henry Brown MAIDEN NAME of Mother Ida Annesty

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

Residence of Father when child was born North Sydney, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Bruen, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Percy Brown Address of Applicant 37 Duke Street, Apt. 3, St. Catharines, Ontario Date 1 August 1967

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of PercyBrown

Born at North Sydney in the County of Cape Breton

That PercyBrown Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on March 29, 1922

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

I am his mother.

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