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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500199

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Leon DouglasSmith Sex Male

Date of Birth December 2, 1919 Place of Birth ShiminicasCounty of Cumberland

Name of Father Walter W Smith MAIDEN NAME of Mother Sarah Elizabeth Black

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

Residence of Father when child was born Lower Shiminicas Present address of Father

Occupation of Father at Birth of child Farmer Place of birth of Father Lower Shiminicas

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

Signature of Applicant Walter W. Smith Address of Applicant Lower Shiminicas Date 10 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Leon DouglasSmith

Born at Shiminicas in the County of Cumberland

That Leon DouglasSmith Whose Birth is sought to be registered was

born at Shiminicas Cumberland County on December 2, 1919

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

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