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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000809

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Benjamin ArchibaldLewis Sex Male

Date of Birth May 26, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father George William Lewis MAIDEN NAME of Mother Bertha Fougere

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

Residence of Father when child was born Sydney, Cape Breton Co. Present address of Father deceased

Occupation of Father at Birth of child Baker Place of birth of Father Charlottetown, Prince Edward Island

Race Name and present address of Physician in attendance at birth

Signature of Applicant Archibald Lewis Address of Applicant 14 Henry Street, Sydney, Cape Breton Co. Date 12 October 1976

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Benjamin ArchibaldLewis

Born at Sydney in the County of Cape Breton

That Benjamin ArchibaldLewis Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 26, 1920

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

This is my own birth

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