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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000816

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Murray JamesPayne Sex Male

Date of Birth March 12, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father William Payne MAIDEN NAME of Mother Mary Smith

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 Miner Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Murray J. Payne Address of Applicant Cowichan Bay, British Columbia Date 18 April 1978

Relationship of Applicant to child Applying for self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Murray JamesPayne

Born at Glace Bay in the County of Cape Breton

That Murray JamesPayne Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on March 12, 1922

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

I was living at home at the time of the birth of my brother Murray James Payne. I was six years. He was born at home and I was present in the house.

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