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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100164

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Carmen LouisAdshade Sex Male

Date of Birth August 3, 1920 Place of Birth MansfieldCounty of Cumberland

Name of Father Henry Louis Adshade MAIDEN NAME of Mother Femmie Elizabeth Faulkner

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

Residence of Father when child was born Mansfield Present address of Father deceased

Occupation of Father at Birth of child Labourer/Farmer Place of birth of Father Mansfield

Race Name and present address of Physician in attendance at birth

Signature of Applicant Carmen Louis Adshade Address of Applicant Truro Date May 1, 1982

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Carmen LouisAdshade

Born at Mansfield in the County of Cumberland

That Carmen LouisAdshade Whose Birth is sought to be registered was

born at Mansfield Cumberland County on August 3, 1920

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

That discharge from Army. Census Certificate and School Register should satisfy anyone of date of birth.

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