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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93602428

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Amos CameronHenry Sex Male

Date of Birth June 28, 1906 Place of Birth River JohnCounty of Pictou

Name of Father Thomas Clark Henry MAIDEN NAME of Mother Mary Bell Cameron

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

Occupation of Father at Birth of child Farmer Place of birth of Father River John

Race Scottish Name and present address of Physician in attendance at birth Dr. J.R. Collie

Signature of Applicant Mary Bell Henry Address of Applicant River John Date 31 August 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Amos CameronHenry

Born at River John in the County of Pictou

That Amos CameronHenry Whose Birth is sought to be registered was

born at River John Pictou County on June 28, 1906

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

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