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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000795

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles DouglasMacFarlane Sex Male

Date of Birth December 20, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father douglas Hugh MacFarlane MAIDEN NAME of Mother Helen Rose Gauthro

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

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

Occupation of Father at Birth of child Newspaper Editor Place of birth of Father Margaree, Inverness

Race Name and present address of Physician in attendance at birth

Signature of Applicant Helen R. MacFarlane Address of Applicant 259 King Edward Street, Glace Bay, Cape Breton Date 20 February 1980

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles DouglasMacFarlane

Born at Glace Bay in the County of Cape Breton

That Charles DouglasMacFarlane Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 20, 1922

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

I am his mother Baptism certificate already submitted

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