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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500056

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Hagen LeroySmith Sex Male

Date of Birth October 28, 1919 Place of Birth WallaceCounty of Cumberland

Name of Father Bligh Milton Smith MAIDEN NAME of Mother Katherine Isabel Angerine

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

Residence of Father when child was born Wallace Bay Present address of Father

Occupation of Father at Birth of child Farmer Place of birth of Father Oxford

Race Name and present address of Physician in attendance at birth Dr. F.D. Chairman

Signature of Applicant Bligh Milton Smith Address of Applicant Wallace Bay Date 22 November 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Hagen LeroySmith

Born at Wallace in the County of Cumberland

That Hagen LeroySmith Whose Birth is sought to be registered was

born at Wallace Cumberland County on October 28, 1919

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

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