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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92800219

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Leslie McKenzieGoreham Sex Male

Date of Birth January 11, 1920 Place of Birth Lower Woods HarbourCounty of Shelburne

Name of Father Everett  Goreham MAIDEN NAME of Mother Winnie Nickerson

Residence of Father when child was born Lower Woods Harbour Present address of Father Knowles P.O.

Occupation of Father at Birth of child Fisherman Place of birth of Father Lower Woods Harbour

Race English Name and present address of Physician in attendance at birth Dr. H.H. Banks, deceased

Signature of Applicant Everett Goreham Address of Applicant Knowles P.O. Date February 24, 1944

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Leslie McKenzieGoreham

Born at Lower Woods Harbour in the County of Shelburne

That Leslie McKenzieGoreham Whose Birth is sought to be registered was

born at Lower Woods Harbour Shelburne County on January 11, 1920

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

I was at home at the time the child was born and do solemnly declare this to be true

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