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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000490

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Walter GordonMoore Sex Male

Date of Birth August 5, 1923 Place of Birth Mill CreekCounty of Cape Breton

Name of Father Charles Moore MAIDEN NAME of Mother Eliza Jane Jessome

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

Residence of Father when child was born Mill Creek Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Mill Creek, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Walter G. Moore Address of Applicant Spryfield, Halifax Co., NS Date 1 March 1974

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Walter GordonMoore

Born at Mill Creek in the County of Cape Breton

That Walter GordonMoore Whose Birth is sought to be registered was

born at Mill Creek Cape Breton County on August 5, 1923

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

Baptismal certificate enclosed.

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