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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700105

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of David RaphaelWaterfield Sex Male

Date of Birth December 1, 1919 Place of Birth Glace BayCounty of Cape Breton

Name of Father Lamuel Joseph Waterfield MAIDEN NAME of Mother Mary Chisholm

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

Residence of Father when child was born Glace Bay Present address of Father 15th Row, New Aberdeen

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

Race Name and present address of Physician in attendance at birth Dr. M.T. Sullivan

Signature of Applicant Mary Waterfield Address of Applicant 15th Row, New Aberdeen, Glace Bay Date 08 January 1920

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of David RaphaelWaterfield

Born at Glace Bay in the County of Cape Breton

That David RaphaelWaterfield Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 1, 1919

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

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