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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200127

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles WilliamSmith Sex Male

Date of Birth October 24, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Frances Peter Smith MAIDEN NAME of Mother Florence Eleanor Howe

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

Residence of Father when child was born Halifax Present address of Father 54 Endicotte Ave.

Occupation of Father at Birth of child Teamster Place of birth of Father St. John's, Nfld

Race Name and present address of Physician in attendance at birth Nurse Kelly

Signature of Applicant Florence Smith Address of Applicant 54 Endicotte Ave. Date 14 November 1919

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles WilliamSmith

Born at Halifax in the County of Halifax

That Charles WilliamSmith Whose Birth is sought to be registered was

born at Halifax Halifax County on October 24, 1919

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

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