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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100358

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarence Roy Smith Sex Male

Date of Birth December 19, 1920 Place of Birth Hammonds PlainsCounty of Halifax

Name of Father Daniel Havelock Smith MAIDEN NAME of Mother Sadie Drucella Awalt

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

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

Occupation of Father at Birth of child Cooper Place of birth of Father Yankeetown

Race Name and present address of Physician in attendance at birth

Signature of Applicant Clarence Roy Smith Address of Applicant Hammonds Plains Date November 21, 1985

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarence Roy Smith

Born at Hammonds Plains in the County of Halifax

That Clarence Roy Smith Whose Birth is sought to be registered was

born at Hammonds Plains Halifax County on December 19, 1920

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

1. School record 2. Marriage extract

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