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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000371

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles WilsonMacLeod Sex Male

Date of Birth September 26, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father Charles Alexander MacLeod MAIDEN NAME of Mother Flora Smith

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

Residence of Father when child was born Port Morien, Cape Breton Present address of Father Port Morien, Cape Breton

Occupation of Father at Birth of child Payroll Clerk Place of birth of Father Port Morien, Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant Flora MacLeod Address of Applicant Port Morien, Cape Breton Date 7 May 1953

Relationship of Applicant to child Self & Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles WilsonMacLeod

Born at Glace Bay in the County of Cape Breton

That Charles WilsonMacLeod Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on September 26, 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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