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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600265

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ralph WilliamMitchell Sex Male

Date of Birth May 30, 1920 Place of Birth DartmouthCounty of Halifax

Name of Father Percy Holloway Mitchell MAIDEN NAME of Mother Maybel Evelyn Merlin

Residence of Father when child was born Dartmouth Present address of Father Dartmouth

Occupation of Father at Birth of child Clerk Place of birth of Father Jeddore, Halifax Co.

Race White Name and present address of Physician in attendance at birth H. A. Payzant M.D, Dartmouth

Signature of Applicant P. H. Mitchell Address of Applicant Dartmouth Date 12 December 1934

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ralph WilliamMitchell

Born at Dartmouth in the County of Halifax

That Ralph WilliamMitchell Whose Birth is sought to be registered was

born at Dartmouth Halifax County on May 30, 1920

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

I am his father

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