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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000941

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ray CharlesConrad Sex Male

Date of Birth August 22, 1920 Place of Birth First SouthCounty of Lunenburg

Name of Father Charles E. Conrad MAIDEN NAME of Mother Arlene R. Zinck

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

Residence of Father when child was born First South Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father First South

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ray C. Conrad Address of Applicant Lunenburg Date November 14, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ray CharlesConrad

Born at First South in the County of Lunenburg

That Ray CharlesConrad Whose Birth is sought to be registered was

born at First South Lunenburg County on August 22, 1920

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

Transcript of Church Records (Baptism) Enclosed and Census Records

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