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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

60600431

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William AverySmith Sex Male

Date of Birth August 22, 1922 Place of Birth Cape NegroCounty of Shelburne

Name of Father William Murray  Smith MAIDEN NAME of Mother Nema Lydia Slade

Residence of Father when child was born Cape Negro Present address of Father Boston, Massachusetts, USA

Occupation of Father at Birth of child Fisherman Place of birth of Father Cape Negro

Race English Name and present address of Physician in attendance at birth Dr. Wilson

Signature of Applicant Nema Lydia Smith Address of Applicant Cape Negro Date 4 October 1927

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William AverySmith

Born at Cape Negro in the County of Shelburne

That William AverySmith Whose Birth is sought to be registered was

born at Cape Negro Shelburne County on August 22, 1922

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

I am his mother and have personal knowledge of the date of his birth.

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