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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000284

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Kenneth HarmondCook Sex Male

Date of Birth December 16, 1922 Place of Birth YarmouthCounty of Yarmouth

Name of Father Frank George Cook MAIDEN NAME of Mother Mildred Belle Nickerson

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

Residence of Father when child was born Yarmouth Present address of Father Chebogue, Yarmouth

Occupation of Father at Birth of child Farmer Place of birth of Father Chebogue, Yarmouth

Race Name and present address of Physician in attendance at birth

Signature of Applicant Frank G. Cook Address of Applicant Chebogue, Yarmouth Date 7 July 1962

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Kenneth HarmondCook

Born at Yarmouth in the County of Yarmouth

That Kenneth HarmondCook Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on December 16, 1922

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

I am the father of the said Kenneth Harmond Cook and was present when he was born. School and bible records.

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