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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000193

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William JamesClyburn Sex Male

Date of Birth May 13, 1923 Place of Birth Glace BayCounty of Cape Breton

Name of Father Norman Clyburn MAIDEN NAME of Mother Jane MacDonald

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

Residence of Father when child was born Glace Bay Cape Breton Co. Ns Present address of Father 6 York Street, Glace Bay, Cape Breton Co., NS

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant W. J. Clyburn Address of Applicant 373 King Edward Street, Glace Bay, Cape Breton Co., NS Date 13 October 1955

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William JamesClyburn

Born at Glace Bay in the County of Cape Breton

That William JamesClyburn Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on May 13, 1923

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

I am his mother. Enclosed is baptismal certificate

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