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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000459

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Louis KeithBarkhouse Sex Male

Date of Birth October 30, 1920 Place of Birth Church LakeCounty of Lunenburg

Name of Father Jarred Barkhouse MAIDEN NAME of Mother Lily  Barkhouse

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

Residence of Father when child was born Church Lake Present address of Father deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Church Lake

Race White Name and present address of Physician in attendance at birth

Signature of Applicant Louis Keith Barkhouse Address of Applicant Date

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Louis KeithBarkhouse

Born at Church Lake in the County of Lunenburg

That Louis KeithBarkhouse Whose Birth is sought to be registered was

born at Church Lake Lunenburg County on October 30, 1920

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

That I was a near neighbour in the community where child was born - Arnold L. Barkhouse

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