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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93602262

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Vernon L.Smith Sex Male

Date of Birth March 28, 1906 Place of Birth WestfieldCounty of Queens

Name of Father Frederick Smith MAIDEN NAME of Mother Mary Mansfield

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

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

Race Anglo-Saxon Name and present address of Physician in attendance at birth Dr. N.H. Cole

Signature of Applicant Mary Smith Address of Applicant Westfield Date 26 April 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Vernon L.Smith

Born at Westfield in the County of Queens

That Vernon L.Smith Whose Birth is sought to be registered was

born at Westfield Queens County on March 28, 1906

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

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