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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000909

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth February 6, 1924 Place of Birth SpringhillCounty of Cumberland

Name of Father Henry Charles Brine MAIDEN NAME of Mother Bertha Mae Dujay

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

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

Occupation of Father at Birth of child Miner (coal) Place of birth of Father Joggins

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gerald Brine Address of Applicant Gables Lodge Ltd. Date April 13, 1988

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Springhill in the County of Cumberland

That GeraldBrine Whose Birth is sought to be registered was

born at Springhill Cumberland County on February 6, 1924

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

Attached original certificate of Baptism Applicants sister Mrs. June Mills, River Phillip, NS own knowledge

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