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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000363

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gerald LewisCleveland Sex

Date of Birth January 8, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father Josiah Cleveland MAIDEN NAME of Mother Mary Christine Topple

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

Residence of Father when child was born Spryfield Present address of Father deceased

Occupation of Father at Birth of child Janitor Place of birth of Father Lunenburg

Race Dutch Name and present address of Physician in attendance at birth Deceased

Signature of Applicant Gerald Cleveland Address of Applicant St. Paul's Avenue, Herring Cove Date April 6, 1962

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gerald LewisCleveland

Born at Halifax in the County of Halifax

That Gerald LewisCleveland Whose Birth is sought to be registered was

born at Halifax Halifax County on January 8, 1920

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

Census & School Records.

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