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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600703

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John EllisonKempton Sex Male

Date of Birth February 3, 1920 Place of Birth Harmony MillCounty of Queens

Name of Father Gilford Ashton Kempton MAIDEN NAME of Mother Harriet Sheffes

Residence of Father when child was born Harmony Mill Present address of Father Harmony Mill

Occupation of Father at Birth of child Lumberman Place of birth of Father Harmony Mill

Race Canadian Name and present address of Physician in attendance at birth Dr. A.C. McLeod, Caledonia

Signature of Applicant Mrs. Harriet Kempton Address of Applicant Harmony Mill Date April 27, 1938

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John EllisonKempton

Born at Harmony Mill in the County of Queens

That John EllisonKempton Whose Birth is sought to be registered was

born at Harmony Mill Queens County on February 3, 1920

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

I am his mother

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