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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200502

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 29, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Thomas Smith MAIDEN NAME of Mother Elizabeth Doward

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

Residence of Father when child was born Halifax Present address of Father 22 Maine Ave.

Occupation of Father at Birth of child Labourer Place of birth of Father Manchester, England

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

Signature of Applicant Elizabeth Smith Address of Applicant 22 Maine Ave. Date 12 February1920

Relationship of Applicant to child mother

AFFIDAVIT

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

Born at Halifax in the County of Halifax

That Smith Whose Birth is sought to be registered was

born at Halifax Halifax County on December 29, 1919

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

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