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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000565

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John ReillyDillon Sex Male

Date of Birth January 31, 1922 Place of Birth Sydney MinesCounty of Cape Breton

Name of Father John Dillon MAIDEN NAME of Mother Kate Bennet

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

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

Occupation of Father at Birth of child Miner Place of birth of Father Scotland

Race Name and present address of Physician in attendance at birth

Signature of Applicant John R. Dillon Address of Applicant 257 Cope Street, Hamilton, Ontario Date 12 January 1976

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John ReillyDillon

Born at Sydney Mines in the County of Cape Breton

That John ReillyDillon Whose Birth is sought to be registered was

born at Sydney Mines Cape Breton County on January 31, 1922

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

Baptismal certificate enclosed

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