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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100202

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 21, 1920 Place of Birth North PrestonCounty of Halifax

Name of Father Willoughby Johnson MAIDEN NAME of Mother Annie Banks

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

Residence of Father when child was born North Preston Present address of Father deceased

Occupation of Father at Birth of child Place of birth of Father North Preston

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sandra Brooks Address of Applicant Dartmouth Date March 4, 1983

Relationship of Applicant to child Daughter

AFFIDAVIT

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

Born at North Preston in the County of Halifax

That WilloughbyJohnson Whose Birth is sought to be registered was

born at North Preston Halifax County on January 21, 1920

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

1. School Extract 2. Marriage Extract 3. National Registration

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