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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000414

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lawrence StephenHeisler Sex Male

Date of Birth October 24, 1921 Place of Birth Martins RiverCounty of Lunenburg

Name of Father Stephen M. Heisler MAIDEN NAME of Mother Jennie Zwicker

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

Residence of Father when child was born Martins River Present address of Father deceased

Occupation of Father at Birth of child Fishing Place of birth of Father Indian Point

Race German Name and present address of Physician in attendance at birth Dr. Chisholm

Signature of Applicant Lawrence S. Heisler Address of Applicant Timberlea Date September 2, 1969

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lawrence StephenHeisler

Born at Martins River in the County of Lunenburg

That Lawrence StephenHeisler Whose Birth is sought to be registered was

born at Martins River Lunenburg County on October 24, 1921

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

Baptism Certificate

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