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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93602179

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Carl WendellRoss Sex Male

Date of Birth December 17, 1906 Place of Birth BaccaroCounty of Shelburne

Name of Father Herbert Ross MAIDEN NAME of Mother Nora Smith

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

Occupation of Father at Birth of child Fisherman Place of birth of Father Cape Sable Island

Race English Name and present address of Physician in attendance at birth Dr. Howard Wilson

Signature of Applicant Carl Wendell Ross Address of Applicant East Baccaro Date 13 March 1926

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Carl WendellRoss

Born at Baccaro in the County of Shelburne

That Carl WendellRoss Whose Birth is sought to be registered was

born at Baccaro Shelburne County on December 17, 1906

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

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