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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000806

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gerald RichardHiltz Sex Male

Date of Birth January 11, 1922 Place of Birth HalifaxCounty of Halifax

Name of Father John Angus Hiltz MAIDEN NAME of Mother Eileen Victoria Murphy

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

Residence of Father when child was born Halifax Present address of Father Deceased

Occupation of Father at Birth of child Freight Handler Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gerald R. Hiltz Address of Applicant 6007 Charles Street, Halifax Date 7 May 1980

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gerald RichardHiltz

Born at Halifax in the County of Halifax

That Gerald RichardHiltz Whose Birth is sought to be registered was

born at Halifax Halifax County on January 11, 1922

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

Baptismal certificate

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