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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500205

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Fredrick CortlineEmbree Sex Male

Date of Birth December 23, 1919 Place of Birth Chignecto MinesCounty of Cumberland

Name of Father Conrad Basil Embree MAIDEN NAME of Mother Hilda Ripley

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

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

Occupation of Father at Birth of child Miner Place of birth of Father Springhill

Race Name and present address of Physician in attendance at birth Dr. A.E. Forbes

Signature of Applicant Conrad Basil Embree Address of Applicant Chignecto Date 07 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Fredrick CortlineEmbree

Born at Chignecto Mines in the County of Cumberland

That Fredrick CortlineEmbree Whose Birth is sought to be registered was

born at Chignecto Mines Cumberland County on December 23, 1919

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

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