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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93300543

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ford MaxwellSullivan Sex Male

Date of Birth January 19, 1906 Place of Birth BerwickCounty of Kings

Name of Father Forester Sullivan MAIDEN NAME of Mother Mary Feinote

Residence of Father when child was born Berwick Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Berwick

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

Signature of Applicant Mary P. Sullivan Address of Applicant Berwick Date 19 October 1925

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ford MaxwellSullivan

Born at Berwick in the County of Kings

That Ford MaxwellSullivan Whose Birth is sought to be registered was

born at Berwick Kings County on January 19, 1906

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

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