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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500031

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 16, 1919 Place of Birth Shinimicas BridgeCounty of Cumberland

Name of Father Harris Hibbert Smith MAIDEN NAME of Mother May O'Brien

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

Residence of Father when child was born Shinimicas Bridge Present address of Father

Occupation of Father at Birth of child Farmer Place of birth of Father Shinimicas Bridge

Race Name and present address of Physician in attendance at birth Dr. E.P. Atkinson

Signature of Applicant May Smith Address of Applicant Shinimicas Bridge Date 12 January 1920

Relationship of Applicant to child mother

AFFIDAVIT

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

Born at Shinimicas Bridge in the County of Cumberland

That Smith Whose Birth is sought to be registered was

born at Shinimicas Bridge Cumberland County on October 16, 1919

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

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