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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100166

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Luther StephenCarver Sex Male

Date of Birth September 29, 1921 Place of Birth WaldonCounty of Lunenburg

Name of Father William Guy Carver MAIDEN NAME of Mother Alice Bertha Keddy

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Luther S. Carver Address of Applicant RR1 Blockhouse Date February 19, 1986

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Luther StephenCarver

Born at Waldon in the County of Lunenburg

That Luther StephenCarver Whose Birth is sought to be registered was

born at Waldon Lunenburg County on September 29, 1921

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

Certificate of Baptism Statement from Rev. R. Weaver

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