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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100033

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarence ClydeLevy Sex Male

Date of Birth June 15, 1920 Place of Birth Moose HarbourCounty of Queens

Name of Father Charles Levy MAIDEN NAME of Mother Irene Blanche  Wilson

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

Residence of Father when child was born Moose Harbour Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Little Tancook Island

Race Name and present address of Physician in attendance at birth

Signature of Applicant Clarence Levy Address of Applicant Mersey Point Date September 12, 1979

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarence ClydeLevy

Born at Moose Harbour in the County of Queens

That Clarence ClydeLevy Whose Birth is sought to be registered was

born at Moose Harbour Queens County on June 15, 1920

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

Doctor's Certificate

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