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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200254

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Church Sex Male

Date of Birth November 15, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Loren Benjamin Church MAIDEN NAME of Mother Pauline Mills

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

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

Occupation of Father at Birth of child Marine engineer Place of birth of Father Chester

Race Name and present address of Physician in attendance at birth Dr. George MacIntosh and Dr. C. Morton

Signature of Applicant Pauline Church Address of Applicant Halifax Date 03 December 1919

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Church

Born at Halifax in the County of Halifax

That Church Whose Birth is sought to be registered was

born at Halifax Halifax County on November 15, 1919

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

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