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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000274

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of James EdmundDouglas Sex Male

Date of Birth July 24, 1921 Place of Birth TidnishCounty of Cumberland

Name of Father James William Douglas MAIDEN NAME of Mother Norma Agnes Chapman

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

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

Occupation of Father at Birth of child Blacksmith and Farmer Place of birth of Father Upper Tidnish, New Brunswick

Race White Name and present address of Physician in attendance at birth Dr. Allen, Port Elgin, New Brunswick (deceased)

Signature of Applicant James Edmund Douglas Address of Applicant Tidnish Date April 26, 1960

Relationship of Applicant to child Mr. Douglas is applying for his own

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of James EdmundDouglas

Born at Tidnish in the County of Cumberland

That James EdmundDouglas Whose Birth is sought to be registered was

born at Tidnish Cumberland County on July 24, 1921

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

I had a son born on August 16, 1921 and remember the date of James Douglas' birth because he was born such a short time before my own son. Family Record and Insurance Record verified by School Record.

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