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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000015

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roy WilliamFredericks Sex Male

Date of Birth January 2, 1922 Place of Birth BedfordCounty of Halifax

Name of Father Winfield Lawrence Fredericks MAIDEN NAME of Mother Hildred May Smith

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

Residence of Father when child was born Bedford, Halifax Present address of Father

Occupation of Father at Birth of child Lumberman Place of birth of Father Oakfield, Maine, USA

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Hildred Fredericks Address of Applicant Bedford, Halifax Date 1 August 1946

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roy WilliamFredericks

Born at Bedford in the County of Halifax

That Roy WilliamFredericks Whose Birth is sought to be registered was

born at Bedford Halifax County on January 2, 1922

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

I am the mother of Roy William Fredericks

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