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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000262

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Robert KeithCook Sex Male

Date of Birth October 13, 1920 Place of Birth ChebogueCounty of Yarmouth

Name of Father Frank George  Cook MAIDEN NAME of Mother Mildred Belle Nickerson

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

Residence of Father when child was born Chebogue Present address of Father Central Chebogue

Occupation of Father at Birth of child Farmer Place of birth of Father Chebogue

Race Canadian Name and present address of Physician in attendance at birth Charles K. Fuller, Yarmouth

Signature of Applicant Mildred Belle Cook Address of Applicant Central Chebogue Date October 1, 1955

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Robert KeithCook

Born at Chebogue in the County of Yarmouth

That Robert KeithCook Whose Birth is sought to be registered was

born at Chebogue Yarmouth County on October 13, 1920

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

Because I am the mother of the above mentioned person wishing registration. Family Bible Record and Certificate from attending Physician's records

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