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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000443

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gerald BlaseDalton Sex Male

Date of Birth January 30, 1924 Place of Birth SydneyCounty of Cape Breton

Name of Father Ronald James Dalton MAIDEN NAME of Mother Margaret Campbell

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

Residence of Father when child was born Sydney, Cape Breton Co., NS Present address of Father Deceased May 17, 1932

Occupation of Father at Birth of child Steel Worker Place of birth of Father Halifax, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gerald B. Dalton Address of Applicant 5 East Street, Sydney, Cape Breton Co., NS Date 27 June 1974

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gerald BlaseDalton

Born at Sydney in the County of Cape Breton

That Gerald BlaseDalton Whose Birth is sought to be registered was

born at Sydney Cape Breton County on January 30, 1924

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

Certificate of Baptism; Extract from marriage record

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