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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000331

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 29, 1921 Place of Birth WentworthCounty of Hants

Name of Father Albert Norris Kelly MAIDEN NAME of Mother Ethel Leighton

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

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

Occupation of Father at Birth of child Labourer Place of birth of Father Walton

Race Irish Name and present address of Physician in attendance at birth Dr. Black

Signature of Applicant Clarissa Wile Address of Applicant Three Mile Plains Date 5 May 1964

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles Graham Kelly

Born at Wentworth in the County of Hants

That Charles Graham Kelly Whose Birth is sought to be registered was

born at Wentworth Hants County on April 29, 1921

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

From living in the same family and being his sister and from Baptismal Certificate

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