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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93401392

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of George HaywardSymonds Sex Male

Date of Birth December 10, 1906 Place of Birth Clarks HarbourCounty of Shelburne

Name of Father Joseph Maddock Symonds MAIDEN NAME of Mother Mary Sophia Kenney

Residence of Father when child was born Clark's Harbour Present address of Father Clark's Harbour

Occupation of Father at Birth of child Fisherman Place of birth of Father Clark's Harbour

Race English Name and present address of Physician in attendance at birth George W. Brown

Signature of Applicant Mary Sophia Symonds Address of Applicant Clark's Harbour Date 6 February 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of George HaywardSymonds

Born at Clarks Harbour in the County of Shelburne

That George HaywardSymonds Whose Birth is sought to be registered was

born at Clarks Harbour Shelburne County on December 10, 1906

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

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