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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200084

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Victor GordenClemens Sex Male

Date of Birth October 16, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father William Clemens MAIDEN NAME of Mother Emma Jane Myrer

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

Residence of Father when child was born Halifax Present address of Father 12 Fredericton Ave.

Occupation of Father at Birth of child Construction Foreman Place of birth of Father Tor Bay, Nfld

Race Name and present address of Physician in attendance at birth Dr. G.M. Campbell

Signature of Applicant Emma Clemens Address of Applicant 12 Fredericton Ave., Halifax Date 13 November 1919

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Victor GordenClemens

Born at Halifax in the County of Halifax

That Victor GordenClemens Whose Birth is sought to be registered was

born at Halifax Halifax County on October 16, 1919

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

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