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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000832

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Walter GeorgeHead Sex Male

Date of Birth June 25, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Adam Head MAIDEN NAME of Mother Louisa Rolfe

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

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

Occupation of Father at Birth of child Steel Worker Place of birth of Father Tilt Cove, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Walter Head Address of Applicant 338 Lingan Road, Sydney, Cape Breton Date 19 January 1981

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Walter GeorgeHead

Born at Sydney in the County of Cape Breton

That Walter GeorgeHead Whose Birth is sought to be registered was

born at Sydney Cape Breton County on June 25, 1922

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

This is my own birth

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