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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500125

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Elmer RandallClarke Sex Female

Date of Birth November 7, 1919 Place of Birth PugwashCounty of Cumberland

Name of Father Hugh Elmer Clarke MAIDEN NAME of Mother Margaret Mary McAleese

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

Residence of Father when child was born Pugwash Present address of Father

Occupation of Father at Birth of child Farmer Place of birth of Father Wallace Bay

Race Name and present address of Physician in attendance at birth Dr. W.V. Goodwin

Signature of Applicant Hugh Clark Address of Applicant Pugwash Date 02 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Elmer RandallClarke

Born at Pugwash in the County of Cumberland

That Elmer RandallClarke Whose Birth is sought to be registered was

born at Pugwash Cumberland County on November 7, 1919

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

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