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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000904

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Anthony NicholasPeori Sex Male

Date of Birth January 3, 1924 Place of Birth DominionCounty of Cape Breton

Name of Father Patrick Peori MAIDEN NAME of Mother Catherine MacDonald

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

Residence of Father when child was born Dominion Present address of Father deceased

Occupation of Father at Birth of child Coal miner Place of birth of Father Florence, Italy

Race Name and present address of Physician in attendance at birth

Signature of Applicant Anthony N. Peori Address of Applicant 11 Queen St. Cambridge, Ontario Date April 20, 1988

Relationship of Applicant to child Same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Anthony NicholasPeori

Born at Dominion in the County of Cape Breton

That Anthony NicholasPeori Whose Birth is sought to be registered was

born at Dominion Cape Breton County on January 3, 1924

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

1) certificate of baptism enclosed 2) parents told me that date.

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