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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000387

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clyde MelvinEarle Sex Male

Date of Birth February 14, 1921 Place of Birth Pleasant LakeCounty of Yarmouth

Name of Father Lyman Edward  Earle MAIDEN NAME of Mother Minnie Gertrude Spates

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

Residence of Father when child was born Pleasant Lake Present address of Father Pleasant Lake

Occupation of Father at Birth of child Carpenter Place of birth of Father Pleasant Lake

Race Caucasian Name and present address of Physician in attendance at birth Dr. Melanson

Signature of Applicant Clyde Melvin Earle Address of Applicant 58 Exhibition St. Kentville Date August 12, 1968

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clyde MelvinEarle

Born at Pleasant Lake in the County of Yarmouth

That Clyde MelvinEarle Whose Birth is sought to be registered was

born at Pleasant Lake Yarmouth County on February 14, 1921

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

Census Record National Registration Record

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