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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000817

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mervin IsaiahClattenburg Sex Male

Date of Birth May 5, 1922 Place of Birth Port MedwayCounty of Queens

Name of Father Leonard Clattenburg MAIDEN NAME of Mother Manson Johnson

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

Residence of Father when child was born Mill Village, Queens Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Mill Village, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant R. E. Crowley Address of Applicant 6944 Leppert Street, Port Medway, Queens Date 9 July 1980

Relationship of Applicant to child Friend

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mervin IsaiahClattenburg

Born at Port Medway in the County of Queens

That Mervin IsaiahClattenburg Whose Birth is sought to be registered was

born at Port Medway Queens County on May 5, 1922

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

Baptismal record and Statistics Canada records.

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