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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000307

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Wilfred VernonRussell Sex Male

Date of Birth September 23, 1922 Place of Birth North BrookfieldCounty of Queens

Name of Father Keith C. Russell MAIDEN NAME of Mother Sadie Grace Hewey

Were the Parents married at the time of the Birth? No

Residence of Father when child was born North Brookfield, Queens Present address of Father Toronto, Ontario

Occupation of Father at Birth of child Farmer Place of birth of Father Molega Mines, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sadie G. Scott Address of Applicant Rest Haven Hospital Date 5 November 1963

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Wilfred VernonRussell

Born at North Brookfield in the County of Queens

That Wilfred VernonRussell Whose Birth is sought to be registered was

born at North Brookfield Queens County on September 23, 1922

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

Baptismal knowledge (mother). Subject is my son, born at my home in North Brookfield. My son gave his birthplace incorrectly and the time of National Registration.

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