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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000289

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

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

Residence of Father when child was born New Waterford Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Nottingham, England

Race Name and present address of Physician in attendance at birth

Signature of Applicant R. G. Mellors Address of Applicant 8936 148th Street, Edmonton, Alberta Date 6 June 1963

Relationship of Applicant to child Self

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:

An examination of certificate of Baptism of Robert George Mellor

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