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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93602236

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Percy LarkenSmith Sex Male

Date of Birth January 12, 1906 Place of Birth CheverieCounty of Hants

Name of Father William Winfred Smith MAIDEN NAME of Mother Caroline Leota Crowell

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

Occupation of Father at Birth of child Labourer Place of birth of Father Newport

Race Caucasian Name and present address of Physician in attendance at birth Dr. E.F. Moore

Signature of Applicant Caroline Leota Smith Address of Applicant Cheverie Date 24 March 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Percy LarkenSmith

Born at Cheverie in the County of Hants

That Percy LarkenSmith Whose Birth is sought to be registered was

born at Cheverie Hants County on January 12, 1906

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

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