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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000618

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Elisha thomasBurgoyne Sex Male

Date of Birth January 4, 1923 Place of Birth St. Margarets BayCounty of Halifax

Name of Father   MAIDEN NAME of Mother Melida Burgoyne

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Elisha Thomas Burgoyne Address of Applicant Callander, Ontario Date 29 June 1976

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Elisha thomasBurgoyne

Born at St. Margarets Bay in the County of Halifax

That Elisha thomasBurgoyne Whose Birth is sought to be registered was

born at St. Margarets Bay Halifax County on January 4, 1923

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

Is based on the oath of L. Evans.

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