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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000682

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Samuel LeoKeough Sex Male

Date of Birth August 3, 1924 Place of Birth SydneyCounty of Cape Breton

Name of Father Andrew Joseph Geough MAIDEN NAME of Mother Hannah Ryan

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 Sydney, Cape Breton Co., NS

Occupation of Father at Birth of child Steel Worker Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant L. Keough Address of Applicant Box 58, RR #1, Kleinburg, Ontario Date 14 July 1980

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Samuel LeoKeough

Born at Sydney in the County of Cape Breton

That Samuel LeoKeough Whose Birth is sought to be registered was

born at Sydney Cape Breton County on August 3, 1924

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

Baptismal Certificate (enclosed)

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