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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000852

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth March 30, 1923 Place of Birth North SydneyCounty of Cape Breton

Name of Father George Bungay MAIDEN NAME of Mother Jane Dicks

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

Residence of Father when child was born North Sydney Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child William Bungay Place of birth of Father illegible

Race Name and present address of Physician in attendance at birth

Signature of Applicant William Bungay Address of Applicant Illegible Date 25 March 1983

Relationship of Applicant to child same

AFFIDAVIT

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

Born at North Sydney in the County of Cape Breton

That WilliamBungay Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on March 30, 1923

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

Baptismal certificate

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