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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000506

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Stewart CarlyleFuller Sex Male

Date of Birth July 20, 1920 Place of Birth YarmouthCounty of Yarmouth

Name of Father Charles Knowles Fuller MAIDEN NAME of Mother  MacKean

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

Residence of Father when child was born Yarmouth Present address of Father Clyde River, Shelburne County

Occupation of Father at Birth of child Physician Place of birth of Father Yarmouth

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

Signature of Applicant S.C. Fuller Address of Applicant Bedford Date

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Stewart CarlyleFuller

Born at Yarmouth in the County of Yarmouth

That Stewart CarlyleFuller Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on July 20, 1920

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

I, Charles K. Fuller BA, M.B.Ch.B., MD, F.R.C.B. (Edin), F.R.C.S. (Canada), a duly registered Medical Practitioner in Nova Scotia did in Yarmouth, on the 20th day of July in the year 1920 did assist my Father Albert J. Fuller, M.D. (deceased) a registered Medical Practitioner in Nova Scotia when Ethel Mary Fuller my wife gave birth to a son named Stewart Carlyle Fuller now residing in Bedford, Halifax County

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