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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000214

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ivan DeltonSmith Sex Male

Date of Birth March 10, 1920 Place of Birth SambroCounty of Halifax

Name of Father Henry Webster Smith MAIDEN NAME of Mother Hannah Elisabeth Gray

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

Residence of Father when child was born Sambro Present address of Father Sambro

Occupation of Father at Birth of child Fisherman Place of birth of Father Sambro

Race White Name and present address of Physician in attendance at birth midwife

Signature of Applicant I.D. Smith Address of Applicant 27 Pine St. Dartmouth Date February 22, 1954

Relationship of Applicant to child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ivan DeltonSmith

Born at Sambro in the County of Halifax

That Ivan DeltonSmith Whose Birth is sought to be registered was

born at Sambro Halifax County on March 10, 1920

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

Enclosed is a Baptism Certificate from St. James United Church Records

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