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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100197

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of ErnestClark Sex Male

Date of Birth May 5, 1920 Place of Birth SpringhillCounty of Cumberland

Name of Father Walter Clark MAIDEN NAME of Mother Hilda DeWolfe

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

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

Occupation of Father at Birth of child Miner Place of birth of Father Springhill

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jacqueline Roe Address of Applicant Halifax Date January 28, 1983

Relationship of Applicant to child niece

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of ErnestClark

Born at Springhill in the County of Cumberland

That ErnestClark Whose Birth is sought to be registered was

born at Springhill Cumberland County on May 5, 1920

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

Baptismal Census Record

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