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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000789

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 23, 1922 Place of Birth DominionCounty of Cape Breton

Name of Father Michael Graham MAIDEN NAME of Mother Mary MacLean

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

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

Occupation of Father at Birth of child Coal miner Place of birth of Father Dominion, Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant Michael Graham Address of Applicant 35 Kings Road, Dominion, Cape Breton Date 30 January 1980

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Dominion in the County of Cape Breton

That MichaelGraham Whose Birth is sought to be registered was

born at Dominion Cape Breton County on April 23, 1922

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

Certification from parish records, Immaculate Conception Church, Dominion, Cape Breton

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