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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000662

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of James ScottSellers Sex Male

Date of Birth April 22, 1921 Place of Birth River JohnCounty of Pictou

Name of Father John W. Sellers MAIDEN NAME of Mother Jessie Catherine MacKay

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

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

Occupation of Father at Birth of child C.N.R. Employee Place of birth of Father River John

Race Name and present address of Physician in attendance at birth

Signature of Applicant James Scott Sellers Address of Applicant River John Date October 21, 1976

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of James ScottSellers

Born at River John in the County of Pictou

That James ScottSellers Whose Birth is sought to be registered was

born at River John Pictou County on April 22, 1921

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

Family Bible Proof Birth of James Scott Sellers as take from Documents of the late Dr. D.A. Murray signed by daughter Jean M. Langille.

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