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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000033

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Austin GordonColquhoun Sex Male

Date of Birth May 6, 1920 Place of Birth Clarks HarbourCounty of Shelburne

Name of Father Gordon Allan Coquhoun MAIDEN NAME of Mother Daisy Mildred Nickerson

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

Residence of Father when child was born Clark's Harbour Present address of Father Sand Beach

Occupation of Father at Birth of child Merchant Place of birth of Father Newellton

Race Scottish Name and present address of Physician in attendance at birth Dr. G.W. Brown

Signature of Applicant Gordon A. Colquhoun Address of Applicant Sand Beach Date April 12, 1947

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Austin GordonColquhoun

Born at Clarks Harbour in the County of Shelburne

That Austin GordonColquhoun Whose Birth is sought to be registered was

born at Clarks Harbour Shelburne County on May 6, 1920

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

I was there

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