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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200391

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

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

Name of Father Fredrick Casselman MAIDEN NAME of Mother Alice Alletty

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

Residence of Father when child was born Ontario Present address of Father 23 Edward St., Brockville, Ontario

Occupation of Father at Birth of child Moulder Place of birth of Father Brockville, Ontario

Race Name and present address of Physician in attendance at birth Dr. R.C.G. Hawkins

Signature of Applicant Fredrick Casselman Address of Applicant Brockville, Ontario Date 26 December 1919

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Halifax in the County of Halifax

That John HalifaxCasselman Whose Birth is sought to be registered was

born at Halifax Halifax County on December 13, 1919

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

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