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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000725

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Wordlow Willard ClevelandJeffrey Sex

Date of Birth July 31, 1920 Place of Birth Harris IslandCounty of Yarmouth

Name of Father James  Jeffrey MAIDEN NAME of Mother Hattie Nickerson

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

Residence of Father when child was born Harris Island Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Upper Wood Harbour

Race White Name and present address of Physician in attendance at birth Dr. W.C. O'Brien, Wedgeport

Signature of Applicant Mrs. Venetia Chatwynd Address of Applicant Up, Wood Harbour Date

Relationship of Applicant to child Aunt

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Wordlow Willard ClevelandJeffrey

Born at Harris Island in the County of Yarmouth

That Wordlow Willard ClevelandJeffrey Whose Birth is sought to be registered was

born at Harris Island Yarmouth County on July 31, 1920

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

I was also living on this small Island at the time of Birth and have knowledge that this is the correct birthdate.

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