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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200404

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarence EdwardCoppinger Sex Male

Date of Birth December 16, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father John Joseph Coppinger MAIDEN NAME of Mother Clara Elizabeth Martin

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

Residence of Father when child was born Halifax Present address of Father 58 Birmingham St.

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

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

Signature of Applicant John Joseph Coppinger Address of Applicant 58 Birmingham St. Date 26 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarence EdwardCoppinger

Born at Halifax in the County of Halifax

That Clarence EdwardCoppinger Whose Birth is sought to be registered was

born at Halifax Halifax County on December 16, 1919

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

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