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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000611

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of George WilliamPotter Sex Male

Date of Birth October 21, 1920 Place of Birth AmherstCounty of Cumberland

Name of Father William Edward Potter MAIDEN NAME of Mother Eleanor Beswick Johnson

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

Residence of Father when child was born Amherst Present address of Father Quebec

Occupation of Father at Birth of child Canada Car Place of birth of Father London, England

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

Signature of Applicant George William Potter Address of Applicant Oshawa, Ontario Date October 6, 1972

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of George WilliamPotter

Born at Amherst in the County of Cumberland

That George WilliamPotter Whose Birth is sought to be registered was

born at Amherst Cumberland County on October 21, 1920

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

Baptism Certificate. I have a brother, Charles Edward Potter. Born [in] Amherst on June 7th, 1919 and a sister Mrs. McBride (nee Eleanor Mary Potter) born April4th, registered in your office.

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