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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500235

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Carmen MurrayDavis Sex Male

Date of Birth December 24, 1919 Place of Birth SpringhillCounty of Cumberland

Name of Father Daniel Davis MAIDEN NAME of Mother Rose Mancle Smith

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

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

Occupation of Father at Birth of child Miner Place of birth of Father Five Islands

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

Signature of Applicant Rose Mancle Davis Address of Applicant Springhill Date 10 January 1920

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Carmen MurrayDavis

Born at Springhill in the County of Cumberland

That Carmen MurrayDavis Whose Birth is sought to be registered was

born at Springhill Cumberland County on December 24, 1919

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

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