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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93501895

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Randolph H.Lewis Sex Male

Date of Birth March 12, 1906 Place of Birth KemptCounty of Queens

Name of Father Robert Lewis MAIDEN NAME of Mother Ruth Ford

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

Occupation of Father at Birth of child Farmer Place of birth of Father New Grafton

Race English Name and present address of Physician in attendance at birth Dr. C.R. Gates

Signature of Applicant Ruth Lewis Address of Applicant Kempt Date 5 April 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Randolph H.Lewis

Born at Kempt in the County of Queens

That Randolph H.Lewis Whose Birth is sought to be registered was

born at Kempt Queens County on March 12, 1906

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

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