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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500096

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clara BeatriceElliott Sex Female

Date of Birth November 28, 1919 Place of Birth AmherstCounty of Cumberland

Name of Father Frank James Elliott MAIDEN NAME of Mother Beatrice May Clarke

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

Residence of Father when child was born Amherst Present address of Father 15 Cornwall St.

Occupation of Father at Birth of child Merchant Place of birth of Father St. John, NB

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

Signature of Applicant Beatrice May Elliott Address of Applicant 15 Cornwall St. Date 29 January 1920

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clara BeatriceElliott

Born at Amherst in the County of Cumberland

That Clara BeatriceElliott Whose Birth is sought to be registered was

born at Amherst Cumberland County on November 28, 1919

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

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