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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000456

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Syanley AddisonClooney Sex Male

Date of Birth November 1, 1922 Place of Birth Five Mile RiverCounty of Hants

Name of Father Garfield Clooney MAIDEN NAME of Mother Eliza Romard

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

Residence of Father when child was born Maitland, Hants Present address of Father Five Mile River, Hants

Occupation of Father at Birth of child Farmer Place of birth of Father Sherbrook, Guysborough

Race Name and present address of Physician in attendance at birth

Signature of Applicant G. Clooney Address of Applicant Maitland, Hants Date 9 August 1929

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Syanley AddisonClooney

Born at Five Mile River in the County of Hants

That Syanley AddisonClooney Whose Birth is sought to be registered was

born at Five Mile River Hants County on November 1, 1922

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

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