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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000309

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Osgood LassellesRoss Sex Male

Date of Birth May 25, 1922 Place of Birth South SideCounty of Shelburne

Name of Father Ira Ross MAIDEN NAME of Mother Lola Nickerson

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

Residence of Father when child was born South Side, Shelburne Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Stony Island, Shelburne

Race Name and present address of Physician in attendance at birth

Signature of Applicant Rita Ross Address of Applicant Newellton, Shelburne Date 12 April 1964

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Osgood LassellesRoss

Born at South Side in the County of Shelburne

That Osgood LassellesRoss Whose Birth is sought to be registered was

born at South Side Shelburne County on May 25, 1922

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

I was the midwife in attendance at the time of birth Mrs. Ross being a near neighbour of mine. I can also cite the time of birth accurately from my marriage 6 July 1920

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