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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000381

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rex Charles HenrySmith Sex

Date of Birth July 28, 1920 Place of Birth Halifax, 24 Smith St.County of Halifax

Name of Father Loraine Otto Smith MAIDEN NAME of Mother Lena Maud Baldwin

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

Residence of Father when child was born 24 Smith St., Halifax Present address of Father 99 Exhibition St. Kentville

Occupation of Father at Birth of child Operator of Street Cars Place of birth of Father Lunenburg

Race White Name and present address of Physician in attendance at birth Dr. Saul Keshen, Halifax

Signature of Applicant Rex C.H. Smith Address of Applicant 30 Howe St., Dartmouth Date December 7, 1965

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rex Charles HenrySmith

Born at Halifax, 24 Smith St. in the County of Halifax

That Rex Charles HenrySmith Whose Birth is sought to be registered was

born at Halifax, 24 Smith St. Halifax County on July 28, 1920

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

That I Loraine Otto Smith, Father of Rex Charles Henry Smith was present at the birth of my Son on July 28, 1920 at 24 Smith St., Halifax.

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