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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000196

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Thomas LewelynLacey Sex Male

Date of Birth July 5, 1922 Place of Birth SpryfieldCounty of Halifax

Name of Father William H. Lacey MAIDEN NAME of Mother Florence Smith

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

Residence of Father when child was born Spryfield, Halifax Present address of Father 2 Ochterloney Street, Dartmouth

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. F. Mass Address of Applicant Bedford Date 14 October 1955

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Thomas LewelynLacey

Born at Spryfield in the County of Halifax

That Thomas LewelynLacey Whose Birth is sought to be registered was

born at Spryfield Halifax County on July 5, 1922

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

Baptism certificate. Mother

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