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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000045

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles FrederickHickey Sex Male

Date of Birth February 15, 1923 Place of Birth HalifaxCounty of Halifax

Name of Father   MAIDEN NAME of Mother Rose Gannon

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Rose Hickey Address of Applicant 33 John Street, Halifax, NS Date 15 October 1947

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles FrederickHickey

Born at Halifax in the County of Halifax

That Charles FrederickHickey Whose Birth is sought to be registered was

born at Halifax Halifax County on February 15, 1923

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

I am the mother of Charles Frederick Hickey - signed Rose Hickey

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