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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93501683

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles HenryDavis Sex Male

Date of Birth June 6, 1906 Place of Birth Millers CreekCounty of Hants

Name of Father Henry Davis MAIDEN NAME of Mother Mattie O'Toole

Residence of Father when child was born Millers Creek Present address of Father Belmont

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

Race English Name and present address of Physician in attendance at birth Dr. C.M. Weeks

Signature of Applicant Charles Henry Davis Address of Applicant Belmont Date 22 March 1926

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles HenryDavis

Born at Millers Creek in the County of Hants

That Charles HenryDavis Whose Birth is sought to be registered was

born at Millers Creek Hants County on June 6, 1906

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

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