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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93300518

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Emery PhilipSmith Sex Male

Date of Birth December 25, 1906 Place of Birth ShelburneCounty of Shelburne

Name of Father Emery Obed Smith MAIDEN NAME of Mother Selma Marion Read

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

Occupation of Father at Birth of child Carpenter Place of birth of Father Short Beach

Race English Name and present address of Physician in attendance at birth Dr. Burns

Signature of Applicant Selma Marion Smith Address of Applicant Shelburne Date 6 November 1925

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Emery PhilipSmith

Born at Shelburne in the County of Shelburne

That Emery PhilipSmith Whose Birth is sought to be registered was

born at Shelburne Shelburne County on December 25, 1906

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

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