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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000872

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Reginald AlliconLutz Sex Male

Date of Birth June 9, 1921 Place of Birth WoodvilleCounty of Kings

Name of Father Breton Perciville Lutz MAIDEN NAME of Mother Evelyn Gertrude Arnold

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

Residence of Father when child was born Woodville Present address of Father Berwick

Occupation of Father at Birth of child Farm Labourer Place of birth of Father Lake Paul

Race Name and present address of Physician in attendance at birth

Signature of Applicant Pam Lutz Address of Applicant Halifax Date February 4, 1980

Relationship of Applicant to child Niece

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Reginald AlliconLutz

Born at Woodville in the County of Kings

That Reginald AlliconLutz Whose Birth is sought to be registered was

born at Woodville Kings County on June 9, 1921

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

He was born at the home of his Aunt (Mrs. Brenton Arnold) at Woodville, Kings N.S. The late Dr. Killam of Woodville was the attending physician.

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