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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200244

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gerald KennethEllis Sex Male

Date of Birth November 13, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Edward Henry Ellis MAIDEN NAME of Mother Kathleen Elizabeth Johnson

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

Residence of Father when child was born Halifax Present address of Father 41 North Park St.

Occupation of Father at Birth of child Storekeeper Place of birth of Father Halifax

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

Signature of Applicant Kathleen Elizabeth Ellis Address of Applicant 41 North Park St. Date 13 November 1919

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gerald KennethEllis

Born at Halifax in the County of Halifax

That Gerald KennethEllis Whose Birth is sought to be registered was

born at Halifax Halifax County on November 13, 1919

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

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