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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200293

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth November 23, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Howard Richard MAIDEN NAME of Mother Jessie Bushe

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

Residence of Father when child was born Halifax Present address of Father 80 St. John Ave.

Occupation of Father at Birth of child Policeman Place of birth of Father Lunenburg Co.

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

Signature of Applicant Howard Richard Address of Applicant 80 St. John Ave. Date 27 November 1919

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Halifax in the County of Halifax

That Richard Whose Birth is sought to be registered was

born at Halifax Halifax County on November 23, 1919

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

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