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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000563

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William Thomas Uloth Sex Male

Date of Birth October 19, 1921 Place of Birth WhiteheadCounty of Guysborough

Name of Father Robert Edward Uloth MAIDEN NAME of Mother Cecelia Florence Armsworth

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant W.T. Uloth Address of Applicant 5837 Macara St. Halifax Date August 22, 1974

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William Thomas Uloth

Born at Whitehead in the County of Guysborough

That William Thomas Uloth Whose Birth is sought to be registered was

born at Whitehead Guysborough County on October 19, 1921

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

Certificate of Baptism

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