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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000925

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of FrederickNickerson Sex Male

Date of Birth December 5, 1921 Place of Birth TickleCounty of Guysborough

Name of Father   MAIDEN NAME of Mother Carrie Nickerson

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Frederick Nickerson Address of Applicant Canso Date April 23, 1981

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of FrederickNickerson

Born at Tickle in the County of Guysborough

That FrederickNickerson Whose Birth is sought to be registered was

born at Tickle Guysborough County on December 5, 1921

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

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