Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
States birth Three Mile Plains, Hants County on October 16, 1921
Male Birth Registration: Year: 1921 number: 63200113
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Registered No. 63200113
PROVINCE OF NOVA SCOTIA
CERTIFICATE OF REGISTRATION OF BIRTH
1. PLACE OF BIRTH
County of Hants
City, Town or Village Three Mile Plains
2. FULL NAME OF CHILD States,
3. Sex of child
Male
4. Twin, triplet or other?
5. Was the child born alive?
Yes
6. Legitimate?
Yes
7. Date of Birth
October 16, 1921
FATHER
8. Full Name George States
9. Residence Three Mile Plains
10. Racial Origin Colored | 11. Age at last birthday 19
12. Birthplace Three Mile Plains
13. Occupation: —
(a) Trade or profession Quarryman
(b) Business in which employed Wentworth Gypsum
MOTHER
14. Full Maiden Name Edith Upshaw
15. Residence Three Mile Plains
16. Racial Origin Colored | 17. Age at last birthday 21
18. Birthplace Three Mile Plains
19. Number of children of this mother (including this child)
Living 1 Dead Stillborn
20. Occupation, if other than household duties
21. Name and Post Office address of Informant George States Three Mile Plains
22. Name of Doctor, nurse or other person in attendance at birth O.B. Keddy M.D.
I certify the foregoing to be true and correct to the best of my knowledge and belief.
Given under my hand this 16 October 1921
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Note: African Nova Scotian