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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93501497

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of FultonBurhoe Sex Male

Date of Birth June 14, 1906 Place of Birth South BrookfieldCounty of Queens

Name of Father John Burhoe MAIDEN NAME of Mother Mary Emmet

Residence of Father when child was born South Brookfield Present address of Father South Brookfield

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

Race Anglo-Saxon Name and present address of Physician in attendance at birth Dr. C.B. Gates

Signature of Applicant Mary Burhoe Address of Applicant South Brookfield Date 29 March 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of FultonBurhoe

Born at South Brookfield in the County of Queens

That FultonBurhoe Whose Birth is sought to be registered was

born at South Brookfield Queens County on June 14, 1906

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

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