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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000532

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Laurie WilfredCollins Sex Male

Date of Birth December 4, 1922 Place of Birth ChignectoCounty of Cumberland

Name of Father John William Collins MAIDEN NAME of Mother Edwena McLellan

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

Residence of Father when child was born Chignecto, Cumberland Present address of Father 82 West Victoria, Amherst, Cumberland

Occupation of Father at Birth of child Labourer Place of birth of Father Pugwash, Cumberland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Laurie Wilfred Collins Address of Applicant Macann, Cumberland Date 18 May 1974

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Laurie WilfredCollins

Born at Chignecto in the County of Cumberland

That Laurie WilfredCollins Whose Birth is sought to be registered was

born at Chignecto Cumberland County on December 4, 1922

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

I am his mother. I remember well his birth date.

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