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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200414

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 17, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father John Kellock MAIDEN NAME of Mother Rita Viola Bowren

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

Residence of Father when child was born Halifax Present address of Father 10A Endicott Ave.

Occupation of Father at Birth of child Policeman Place of birth of Father Lower Fifishire, Scotland

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

Signature of Applicant John Kellock Address of Applicant 10A Endicott Ave. Date 06 January 1920

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Halifax in the County of Halifax

That John DouglasKellock Whose Birth is sought to be registered was

born at Halifax Halifax County on December 17, 1919

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

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