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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000460

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Regina MaryBurke Sex Female

Date of Birth January 5, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father John A. Burke MAIDEN NAME of Mother Teresa Cozzolino

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

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

Occupation of Father at Birth of child Dentist Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sister Mary John Burke Address of Applicant 6183 Quinpool Road, Halifax Date 18 October 1972

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Regina MaryBurke

Born at Sydney in the County of Cape Breton

That Regina MaryBurke Whose Birth is sought to be registered was

born at Sydney Cape Breton County on January 5, 1922

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

Baptismal certificate

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