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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000539

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of RoyFalconer Sex Male

Date of Birth February 13, 1924 Place of Birth SydneyCounty of Cape Breton

Name of Father Thomas Falconer MAIDEN NAME of Mother Eliza Burge

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

Residence of Father when child was born 13 Franklin Street, Sydney, Cape Breton Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Steelworker Place of birth of Father Bonavista, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Roy Falconer Address of Applicant 131 Weidner Drive, Sydney, Cape Breton Co., NS Date May 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of RoyFalconer

Born at Sydney in the County of Cape Breton

That RoyFalconer Whose Birth is sought to be registered was

born at Sydney Cape Breton County on February 13, 1924

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

This is my own birth

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