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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000297

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clinton StarrMansfield Sex Male

Date of Birth May 18, 1922 Place of Birth WestfieldCounty of Queens

Name of Father Hastings Mansfield MAIDEN NAME of Mother Rosella Theriau

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

Residence of Father when child was born Westfield, Queens Present address of Father Westfield, Queens

Occupation of Father at Birth of child Laboourer Place of birth of Father Westfield, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant Hastings Mansfield Address of Applicant Westfield, Queens Date 9 December 1958

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clinton StarrMansfield

Born at Westfield in the County of Queens

That Clinton StarrMansfield Whose Birth is sought to be registered was

born at Westfield Queens County on May 18, 1922

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

I am the father of the said Clinton Starr Mansfield and I recall that he was born on the 18th day of May 1922.

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