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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000220

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Laura ElizabethClark Sex Female

Date of Birth April 18, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father George William Clark MAIDEN NAME of Mother Lottie Mae Fleet

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

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

Occupation of Father at Birth of child Stevedore Place of birth of Father England

Race White Name and present address of Physician in attendance at birth Dr. Kelly

Signature of Applicant Lottie Mae Clark Address of Applicant 402 Windsor St. Halifax Date May 1, 1956

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Laura ElizabethClark

Born at Halifax in the County of Halifax

That Laura ElizabethClark Whose Birth is sought to be registered was

born at Halifax Halifax County on April 18, 1921

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

I am the mother of the child (School and Church)

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