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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200341

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John FrancisBelfontaine Sex Male

Date of Birth December 2, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father John Joseph Belfontaine MAIDEN NAME of Mother Hannah Lydia Belfontaine

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

Residence of Father when child was born Halifax Present address of Father 9A Fredericton Ave.

Occupation of Father at Birth of child Machine tool Operator Place of birth of Father Head of Chezzetcook

Race Name and present address of Physician in attendance at birth Dr. C.S. Elliot

Signature of Applicant John Joseph Belfontaine Address of Applicant 9A Fredericton Ave. Date 06 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John FrancisBelfontaine

Born at Halifax in the County of Halifax

That John FrancisBelfontaine Whose Birth is sought to be registered was

born at Halifax Halifax County on December 2, 1919

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

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