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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000362

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of WilliamHead Sex Male

Date of Birth August 10, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father Adam Head MAIDEN NAME of Mother Louisa Ralph

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

Residence of Father when child was born Sydney Cape Breton Co. Ns Present address of Father 70 East Street, Sydney, Cape Breton Co., NS

Occupation of Father at Birth of child Steel Worker Place of birth of Father Bell Island, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant William Head Address of Applicant 128 Indian Road, Kingston, Ontario Date 26 March 1969

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of WilliamHead

Born at Sydney in the County of Cape Breton

That WilliamHead Whose Birth is sought to be registered was

born at Sydney Cape Breton County on August 10, 1923

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

I am the said William Head

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