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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000316

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Breen FrankDriscoll Sex Male

Date of Birth December 29, 1923 Place of Birth HalifaxCounty of Halifax

Name of Father Martin John Driscoll MAIDEN NAME of Mother Rita Elva Conrad

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

Residence of Father when child was born Russell Street Halifax Ns Present address of Father 207 Russell Street, Halifax, NS

Occupation of Father at Birth of child Bread Salesman at Morris Ltd. Place of birth of Father Halifax, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Martin Driscoll Address of Applicant 207 Russell Street, Halifax, NS Date 20 January 1924

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Breen FrankDriscoll

Born at Halifax in the County of Halifax

That Breen FrankDriscoll Whose Birth is sought to be registered was

born at Halifax Halifax County on December 29, 1923

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

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