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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000583

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 10, 1921 Place of Birth SambroCounty of Halifax

Name of Father Charles Nickerson MAIDEN NAME of Mother Florence Findley

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gladys Nickerson Address of Applicant Sambro Date February 28, 1975

Relationship of Applicant to child Wife

AFFIDAVIT

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

Born at Sambro in the County of Halifax

That Clyde FranklinNickerson Whose Birth is sought to be registered was

born at Sambro Halifax County on June 10, 1921

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

Baptism

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