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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000162

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roy IgnatiusMatheson Sex Male

Date of Birth January 9, 1924 Place of Birth Reserve minesCounty of Cape Breton

Name of Father Alexander Matheson MAIDEN NAME of Mother Margeret MacDonald

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

Residence of Father when child was born Reserve Mines, Cape Breton Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Miner Place of birth of Father Glace Bay, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Roy Ignatius Matheson Address of Applicant 5 Cabot Place, Halifax, NS Date 21 September 1955

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roy IgnatiusMatheson

Born at Reserve mines in the County of Cape Breton

That Roy IgnatiusMatheson Whose Birth is sought to be registered was

born at Reserve mines Cape Breton County on January 9, 1924

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

Baptism National registration

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