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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000412

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of James WilliamCleary Sex Male

Date of Birth August 11, 1924 Place of Birth Sable IslandCounty of Halifax

Name of Father William Henry Cleary MAIDEN NAME of Mother Elva Ernestine York

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

Residence of Father when child was born Sable Island, Halifax Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Light Keeper Place of birth of Father Eastern Passage, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Fred Alex Henneberry Address of Applicant Eastern Passage, Halifax Co., NS Date 20 November 1973

Relationship of Applicant to child Stepfather

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of James WilliamCleary

Born at Sable Island in the County of Halifax

That James WilliamCleary Whose Birth is sought to be registered was

born at Sable Island Halifax County on August 11, 1924

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

I am his stepfather

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