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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000173

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Manford BurtonNickerson Sex Male

Date of Birth June 10, 1921 Place of Birth Atwoods BrookCounty of Shelburne

Name of Father Burton Nickerson MAIDEN NAME of Mother Henrietta Swim

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

Residence of Father when child was born Clarks Harbour Present address of Father Clarks Harbour

Occupation of Father at Birth of child Labourer Place of birth of Father Clarks Harbour

Race White Name and present address of Physician in attendance at birth Herbert H. Banks M.D.

Signature of Applicant Henrietta Nickerson Address of Applicant Clarks Harbour Date April 14, 1953

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Manford BurtonNickerson

Born at Atwoods Brook in the County of Shelburne

That Manford BurtonNickerson Whose Birth is sought to be registered was

born at Atwoods Brook Shelburne County on June 10, 1921

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

I am the mother of Manford Burton Nickerson and have knowledge of the fact and date of his birth. (School records and certification from Canadian Pension Commission records)

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