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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700511

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Reginald JosephClarke Sex Male

Date of Birth October 14, 1919 Place of Birth DominionCounty of Cape Breton

Name of Father George Taylor Clarke MAIDEN NAME of Mother Hermine Carabin

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

Residence of Father when child was born Dominion No.4 Present address of Father

Occupation of Father at Birth of child Accountant Place of birth of Father Horbury, Yorkshire, England

Race Name and present address of Physician in attendance at birth Dr. A. Calder

Signature of Applicant George Taylor Clarke Address of Applicant Dominion No. 4 Date 17 October 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Reginald JosephClarke

Born at Dominion in the County of Cape Breton

That Reginald JosephClarke Whose Birth is sought to be registered was

born at Dominion Cape Breton County on October 14, 1919

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

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