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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700092

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lewrena CamellinaPotty Sex Female

Date of Birth December 19, 1919 Place of Birth Sydney MinesCounty of Cape Breton

Name of Father Gardner Potty MAIDEN NAME of Mother Susie Marie Jessome

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

Residence of Father when child was born Sydney Mines Present address of Father

Occupation of Father at Birth of child Mechanic Place of birth of Father Arichat

Race Name and present address of Physician in attendance at birth Dr. David W. Archibald

Signature of Applicant Gardnet Potty Address of Applicant Sydney Mines Date 19 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lewrena CamellinaPotty

Born at Sydney Mines in the County of Cape Breton

That Lewrena CamellinaPotty Whose Birth is sought to be registered was

born at Sydney Mines Cape Breton County on December 19, 1919

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

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