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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000007

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of RoderickSmith Sex Male

Date of Birth October 14, 1921 Place of Birth Indian BrookCounty of Victoria

Name of Father Alex Smith MAIDEN NAME of Mother Mary MacDonald

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

Residence of Father when child was born Indian Brook Present address of Father River Bennett

Occupation of Father at Birth of child Farmer Place of birth of Father Eel Cove

Race Scottish Name and present address of Physician in attendance at birth Mrs. Sarah Morrison midwife

Signature of Applicant Alex Smith Address of Applicant River Bennett Date March 17, 1946

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of RoderickSmith

Born at Indian Brook in the County of Victoria

That RoderickSmith Whose Birth is sought to be registered was

born at Indian Brook Victoria County on October 14, 1921

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

Record in Family Bible

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