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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700386

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Samuel DavidSherwood Sex Male

Date of Birth November 15, 1919 Place of Birth West MountCounty of Cape Breton

Name of Father Joseph Herbine Sherwood MAIDEN NAME of Mother Kejiah Jane DeLouche

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

Residence of Father when child was born West Mount Present address of Father

Occupation of Father at Birth of child Carpenter Place of birth of Father Gabarus

Race Name and present address of Physician in attendance at birth E.M. McDonald

Signature of Applicant Joseph Herbine Sherwood Address of Applicant West Mount Date 13 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Samuel DavidSherwood

Born at West Mount in the County of Cape Breton

That Samuel DavidSherwood Whose Birth is sought to be registered was

born at West Mount Cape Breton County on November 15, 1919

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

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