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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000439

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Elmer GilroyStevens Sex Male

Date of Birth August 12, 1920 Place of Birth ThomsonCounty of Cumberland

Name of Father Murray Leslie Stevens MAIDEN NAME of Mother Viola Rachel Carter

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

Residence of Father when child was born Westchester Present address of Father Pugwash

Occupation of Father at Birth of child Railroad Place of birth of Father Truro

Race English Name and present address of Physician in attendance at birth Dr. Gilroy, deceased

Signature of Applicant Viola R. Stevens Address of Applicant Pugwash Date

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Elmer GilroyStevens

Born at Thomson in the County of Cumberland

That Elmer GilroyStevens Whose Birth is sought to be registered was

born at Thomson Cumberland County on August 12, 1920

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

I am the mother of the applicant, Elmer Gilroy Stevens

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