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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90501440

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Frank RussellIllsley Sex Male

Date of Birth June 24, 1920 Place of Birth Church StreetCounty of Kings

Name of Father Walter Elmer Illsley MAIDEN NAME of Mother Alma Wiles

Residence of Father when child was born Church Street, Kings County Present address of Father Church Street, Kings County

Occupation of Father at Birth of child Farmer Place of birth of Father Hudson, Massachusetts

Race White Name and present address of Physician in attendance at birth William Woodworth, M.D.

Signature of Applicant Walter E. Illsley Address of Applicant Church Street, Kings County Date 6 September 1940

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Frank RussellIllsley

Born at Church Street in the County of Kings

That Frank RussellIllsley Whose Birth is sought to be registered was

born at Church Street Kings County on June 24, 1920

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

I am his father and was present in the house when he was born.

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