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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700377

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth November 6, 1919 Place of Birth FlorenceCounty of Cape Breton

Name of Father William Robert Clarke MAIDEN NAME of Mother Annie Janett McLeod

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

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

Occupation of Father at Birth of child Miner Place of birth of Father Carbonear, Nfld

Race Name and present address of Physician in attendance at birth Dr. Nathaniel McDonald

Signature of Applicant William Robert Clarke Address of Applicant Florence Date 19 November 1919

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Florence in the County of Cape Breton

That FrederickClarke Whose Birth is sought to be registered was

born at Florence Cape Breton County on November 6, 1919

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

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