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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000429

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gerald WillardLively Sex Male

Date of Birth October 26, 1922 Place of Birth Beaver BankCounty of Halifax

Name of Father George Edward Lively MAIDEN NAME of Mother Lena Schunaman

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

Residence of Father when child was born Beaver Bank, Halifax Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Bedford, Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gerald W. Lively Address of Applicant Beaver Bank, Halifax Date September 1971

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gerald WillardLively

Born at Beaver Bank in the County of Halifax

That Gerald WillardLively Whose Birth is sought to be registered was

born at Beaver Bank Halifax County on October 26, 1922

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

As determined from church baptism records

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