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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100176

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Randle LeanderFortune Sex Male

Date of Birth March 22, 1920 Place of Birth StanleyCounty of Cumberland

Name of Father Ranold Fortune MAIDEN NAME of Mother Susan  Forrest

Were the Parents married at the time of the Birth? No

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

Occupation of Father at Birth of child Labourer Place of birth of Father Stanley

Race Name and present address of Physician in attendance at birth

Signature of Applicant Randle L. Fortune Address of Applicant River Philip Date August 11, 1982

Relationship of Applicant to child same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Randle LeanderFortune

Born at Stanley in the County of Cumberland

That Randle LeanderFortune Whose Birth is sought to be registered was

born at Stanley Cumberland County on March 22, 1920

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

I was advised by my mother of the aforesaid facts and I have always celebrated my birthdate as on the aforesaid date and such information is confirmed by the Census Records and School Records

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