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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000611

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Alvin NathanNickerson Sex Male

Date of Birth July 6, 1922 Place of Birth Forest GlenCounty of Yarmouth

Name of Father Smith Nickerson MAIDEN NAME of Mother Blanch Cosman

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

Residence of Father when child was born Forest Glen, Yarmouth Present address of Father Weymouth, Digby

Occupation of Father at Birth of child Merchant Place of birth of Father Richfield, Digby

Race Name and present address of Physician in attendance at birth

Signature of Applicant Herbert C. Nickerson Address of Applicant Deerfield, Yarmouth Date 14 December 1976

Relationship of Applicant to child Uncle

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Alvin NathanNickerson

Born at Forest Glen in the County of Yarmouth

That Alvin NathanNickerson Whose Birth is sought to be registered was

born at Forest Glen Yarmouth County on July 6, 1922

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

I am an uncle and know the above facts to be true

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