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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000424

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Seibert AlonzoInnis Sex Male

Date of Birth January 17, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Arden Innis MAIDEN NAME of Mother Gladys Hooper

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

Residence of Father when child was born 24 Currys Lane, Sydney, Cape Breton Present address of Father 30 Currys Lane, Sydney, Cape Breton

Occupation of Father at Birth of child Steel Worker Place of birth of Father Barbados, West Indies

Race Name and present address of Physician in attendance at birth

Signature of Applicant Arden Innis Address of Applicant 30 Currys Lane, Sydney, Cape Breton Date 18 August 1971

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Seibert AlonzoInnis

Born at Sydney in the County of Cape Breton

That Seibert AlonzoInnis Whose Birth is sought to be registered was

born at Sydney Cape Breton County on January 17, 1922

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

that I am the father of Seibert Alonzo who was born in the city of Sydney and that I was present at the birth of the said child, living with my wife at the said address and that the child was baptized in the African Orthodox Church and that the midwife had promised to have the said child registered.

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