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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000867

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gordon ElliottHorne Sex Male

Date of Birth October 31, 1923 Place of Birth Hornes Road, MiraCounty of Cape Breton

Name of Father Thomas Horne MAIDEN NAME of Mother Viola Beatrice Tutty

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

Residence of Father when child was born Horne's Road Mira Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Horne's Road, Mira, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gordon Horne Address of Applicant Apt. 304, 312 Esplanade, Sydney, Cape Breton Co., NS Date 29 June 1983

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gordon ElliottHorne

Born at Hornes Road, Mira in the County of Cape Breton

That Gordon ElliottHorne Whose Birth is sought to be registered was

born at Hornes Road, Mira Cape Breton County on October 31, 1923

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

Attached herewith certificate of baptism Par. Marr Re: Surname "Horne" 26869/21

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