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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000459

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarence LeRoyPierce Sex Male

Date of Birth November 27, 1921 Place of Birth Jordan BayCounty of Shelburne

Name of Father William Pierce MAIDEN NAME of Mother Beatrice Bush

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

Residence of Father when child was born Jordan Bay Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father

Race English Name and present address of Physician in attendance at birth

Signature of Applicant Clarence L. Pierce Address of Applicant 829 Maxwell St. Sarnia, Ontario Date February 1970

Relationship of Applicant to child Child is making application

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarence LeRoyPierce

Born at Jordan Bay in the County of Shelburne

That Clarence LeRoyPierce Whose Birth is sought to be registered was

born at Jordan Bay Shelburne County on November 27, 1921

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

I am the older sister of the applicant and as such am aware of the date and place of his birth

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