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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91602712

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clayton MosesCook Sex Male

Date of Birth September 15, 1920 Place of Birth South OhioCounty of Yarmouth

Name of Father George William Cook MAIDEN NAME of Mother Beatrice Lydia Moses

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

Residence of Father when child was born South Ohio, Yarmouth Co. Present address of Father South Ohio, Yarmouth Co.

Occupation of Father at Birth of child Grocery Business Place of birth of Father South Ohio, Yarmouth Co.

Race White Name and present address of Physician in attendance at birth Dr. Z. Hawkins, South Ohio, Yarmouth Co.

Signature of Applicant Mrs. Beatrice Lydia Cook Address of Applicant South Ohio, Yarmouth Co. Date 5 September 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clayton MosesCook

Born at South Ohio in the County of Yarmouth

That Clayton MosesCook Whose Birth is sought to be registered was

born at South Ohio Yarmouth County on September 15, 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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