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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600327

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Robert GeorgeMellors Sex Male

Date of Birth June 3, 1923 Place of Birth New WaterfordCounty of Cape Breton

Name of Father Percy Mellors MAIDEN NAME of Mother Flora Waterman

Residence of Father when child was born New Waterford, Cape Breton Co., NS Present address of Father 12416 87th Street, Edmonton, Alberta

Occupation of Father at Birth of child Miner Place of birth of Father Lynn Croft, England

Race Name and present address of Physician in attendance at birth

Signature of Applicant P. Mellors Address of Applicant 12416 87th Street, Edmonton, Alberta Date 30 November 1934

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Robert GeorgeMellors

Born at New Waterford in the County of Cape Breton

That Robert GeorgeMellors Whose Birth is sought to be registered was

born at New Waterford Cape Breton County on June 3, 1923

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

Sworn Declaration

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