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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100003

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rory HavelockBurhoe Sex Male

Date of Birth July 28, 1922 Place of Birth South BrookfieldCounty of Queens

Name of Father Gay Theolopus Burhoe MAIDEN NAME of Mother Eleanor Wile

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

Residence of Father when child was born South Brookfield, Queens Present address of Father Deceased

Occupation of Father at Birth of child Farrier Place of birth of Father South Brookfield, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant Knight W. Burhoe Address of Applicant Clifton Royal, Kings, New Brunswick Date 19 August 1984

Relationship of Applicant to child Brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rory HavelockBurhoe

Born at South Brookfield in the County of Queens

That Rory HavelockBurhoe Whose Birth is sought to be registered was

born at South Brookfield Queens County on July 28, 1922

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

I am his older brother and was 11 years old at his date of birth.

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