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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91703670

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarke BerthornKelsey Sex

Date of Birth January 7, 1920 Place of Birth LucasvilleCounty of Halifax

Name of Father Osborne Davis Kelsey MAIDEN NAME of Mother Janett Parson

Residence of Father when child was born Lucasville Present address of Father Middle Sackville

Occupation of Father at Birth of child Laborer Place of birth of Father Middle Sackville

Race African Name and present address of Physician in attendance at birth Mrs. Elizabeth Parson, midwife

Signature of Applicant Mrs. Janett Kelsey Address of Applicant Middle Sackville Date May 7, 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarke BerthornKelsey

Born at Lucasville in the County of Halifax

That Clarke BerthornKelsey Whose Birth is sought to be registered was

born at Lucasville Halifax County on January 7, 1920

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

I am the mother of Clarke Berthorn Kelsey and know he was born January 7, 1920.

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