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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500492

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Frank GordonMack Sex Male

Date of Birth May 15, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father Frank Gordon Mack MAIDEN NAME of Mother Muriel Sculthorpe

Were the Parents married at the time of the Birth? Yes

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

Occupation of Father at Birth of child Physician Place of birth of Father Bridgewater

Race Name and present address of Physician in attendance at birth

Signature of Applicant Frank G Mack Address of Applicant Halifax Date 5 Oct 1939

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Frank GordonMack

Born at Halifax in the County of Halifax

That Frank GordonMack Whose Birth is sought to be registered was

born at Halifax Halifax County on May 15, 1921

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

I am his father and remember the fact

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