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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93602116

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Leland CliftonNickerson Sex Male

Date of Birth August 12, 1906 Place of Birth Woods HarbourCounty of Shelburne

Name of Father Nimrod A. Nickerson MAIDEN NAME of Mother Mary Susan O'Connell

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

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

Race British Name and present address of Physician in attendance at birth Dr. H.H. Banks

Signature of Applicant Mary Susan Nickerson Address of Applicant Wood's Harbour Date 24 April 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Leland CliftonNickerson

Born at Woods Harbour in the County of Shelburne

That Leland CliftonNickerson Whose Birth is sought to be registered was

born at Woods Harbour Shelburne County on August 12, 1906

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

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