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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200037

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of George OglePotts Sex Male

Date of Birth October 8, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father George Ogle Potts MAIDEN NAME of Mother Eva Smith

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

Residence of Father when child was born Halifax Present address of Father Fredricton Ave

Occupation of Father at Birth of child Longshoreman Place of birth of Father England

Race Name and present address of Physician in attendance at birth Dr. Buckley

Signature of Applicant George O. Potts Address of Applicant Fredricton Ave. Date 10 October 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of George OglePotts

Born at Halifax in the County of Halifax

That George OglePotts Whose Birth is sought to be registered was

born at Halifax Halifax County on October 8, 1919

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

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