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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000446

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth February 14, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father George Archibald Sheppard MAIDEN NAME of Mother Jennie Bartlett

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

Residence of Father when child was born Minto Street, Glace Bay, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Electrical Engineer Place of birth of Father Little Bay, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Omar Sheppard Address of Applicant 16 Duncan Street, Glace Bay, Cape Breton Date 10 October 1971

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That OmarSheppard Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on February 14, 1922

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

I am his older brother, born in Glace Bay on January 5, 1916. A certificate of baptism has been submitted..

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