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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000303

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Melvin PercyRoss Sex Male

Date of Birth July 31, 1922 Place of Birth Kempt ShoreCounty of Hants

Name of Father Melvin Fraser Ross MAIDEN NAME of Mother Agnes May Brown

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

Residence of Father when child was born Kempt Shore, Hants Present address of Father Kempt Shore, Hants

Occupation of Father at Birth of child Labourer (Woodsman) Place of birth of Father Cheverie, Hants

Race Name and present address of Physician in attendance at birth

Signature of Applicant Agnes M. Ross Address of Applicant Kempt Shore, Hants Date 18 August 1922

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Melvin PercyRoss

Born at Kempt Shore in the County of Hants

That Melvin PercyRoss Whose Birth is sought to be registered was

born at Kempt Shore Hants County on July 31, 1922

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

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