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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100196

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John Warren SmithCox Sex Male

Date of Birth December 26, 1920 Place of Birth PictouCounty of Pictou

Name of Father John Warren Cox MAIDEN NAME of Mother Blanche Smith

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

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

Occupation of Father at Birth of child Tailor Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant John W. Cox Address of Applicant Sydney Date January 25, 1983

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John Warren SmithCox

Born at Pictou in the County of Pictou

That John Warren SmithCox Whose Birth is sought to be registered was

born at Pictou Pictou County on December 26, 1920

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

I have known the applicant for the past forty years and his father before him. And the Church Baptismal Certificate - James MacDonnell

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