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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000433

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles CarsonAdams Sex Male

Date of Birth April 1, 1920 Place of Birth Lower Five IslandsCounty of Cumberland

Name of Father James Garfield Adams MAIDEN NAME of Mother Electa Cora Webb

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

Residence of Father when child was born Lower Five Islands Present address of Father deceased

Occupation of Father at Birth of child Lumberman Place of birth of Father Lower Five Islands

Race Canadian Name and present address of Physician in attendance at birth Dr. MacKenzie, deceased

Signature of Applicant Fraser D. Adams Address of Applicant Bedford Date August 13, 1966

Relationship of Applicant to child brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles CarsonAdams

Born at Lower Five Islands in the County of Cumberland

That Charles CarsonAdams Whose Birth is sought to be registered was

born at Lower Five Islands Cumberland County on April 1, 1920

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

I am a younger brother of Charles and know his birth date

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