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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000945

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles JosephLong Sex Male

Date of Birth August 9, 1923 Place of Birth North SydneyCounty of Cape Breton

Name of Father Thomas Long MAIDEN NAME of Mother Amelia White

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 Cook Place of birth of Father North Sydney, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Charles Long Address of Applicant 506 Old Sackville Road, Halifax Co., NS Date 20 November 1985

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles JosephLong

Born at North Sydney in the County of Cape Breton

That Charles JosephLong Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on August 9, 1923

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

Baptismal

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