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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000384

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Emmerson ErnestBrown Sex Male

Date of Birth June 28, 1921 Place of Birth WatervilleCounty of Kings

Name of Father William Brown MAIDEN NAME of Mother Lovella Ernst

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

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

Occupation of Father at Birth of child Farmer Place of birth of Father Cornwallis

Race Anglo-Saxon Name and present address of Physician in attendance at birth

Signature of Applicant Emmerson Ernest Brown Address of Applicant 93 Newman St. St. John, New Brunswick Date 13 May 1968

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Emmerson ErnestBrown

Born at Waterville in the County of Kings

That Emmerson ErnestBrown Whose Birth is sought to be registered was

born at Waterville Kings County on June 28, 1921

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

I have always celebrated my birthday on June 28. I am now forty six years old.

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