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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000121

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles RobertGaudett Sex Male

Date of Birth March 22, 1921 Place of Birth South BrookfieldCounty of Queens

Name of Father Valentine Joseph Gaudett MAIDEN NAME of Mother Marie Flossie Spears

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

Residence of Father when child was born South Brookfield Present address of Father South Brookfield

Occupation of Father at Birth of child Lumberman Place of birth of Father Weymouth

Race Anglo-Saxon Name and present address of Physician in attendance at birth Dr. A.C. McLeod

Signature of Applicant Valentine Joseph Gaudett Address of Applicant South Brookfield Date March 21, 1950

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles RobertGaudett

Born at South Brookfield in the County of Queens

That Charles RobertGaudett Whose Birth is sought to be registered was

born at South Brookfield Queens County on March 22, 1921

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

I am his father and know date of his birth also have certificate of attending physician Dr. A.C. McLeod

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