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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000657

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Florence McLeodClarke Sex Female

Date of Birth May 17, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father Leslie Bayfield Clarke MAIDEN NAME of Mother Florence (McLeod)

Were the Parents married at the time of the Birth?

Residence of Father when child was born 109 Water Street, Dartmouth Present address of Father

Occupation of Father at Birth of child Carpenter Place of birth of Father Parrsboro

Race Name and present address of Physician in attendance at birth Dr. Hebb, Miss Lissin

Signature of Applicant Address of Applicant Date September 27, 1920

Relationship of Applicant to child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Florence McLeodClarke

Born at Halifax in the County of Halifax

That Florence McLeodClarke Whose Birth is sought to be registered was

born at Halifax Halifax County on May 17, 1920

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

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