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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000663

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Thomas WilliamSmith Sex Male

Date of Birth February 1, 1922 Place of Birth Sydney MinesCounty of Cape Breton

Name of Father Angus Smith MAIDEN NAME of Mother Gladys West

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

Residence of Father when child was born Sydney Mines, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Theresa M Smith Address of Applicant Milford Station, Hants Date 2 December 1977

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Thomas WilliamSmith

Born at Sydney Mines in the County of Cape Breton

That Thomas WilliamSmith Whose Birth is sought to be registered was

born at Sydney Mines Cape Breton County on February 1, 1922

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

Cradle roll and marriage extract.

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