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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700337

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of SamuelNewman Sex Male

Date of Birth November 1, 1919 Place of Birth New WaterfordCounty of Cape Breton

Name of Father Albert Newman MAIDEN NAME of Mother Dora Jackson

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

Residence of Father when child was born New Waterford Present address of Father

Occupation of Father at Birth of child Miner Place of birth of Father St. John's, Newfoundland

Race Name and present address of Physician in attendance at birth Dr. J.C. Morrison

Signature of Applicant Albert Newman Address of Applicant New Waterford Date 06 November 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of SamuelNewman

Born at New Waterford in the County of Cape Breton

That SamuelNewman Whose Birth is sought to be registered was

born at New Waterford Cape Breton County on November 1, 1919

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

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