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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000936

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Howard LeRoyForrest Sex Male

Date of Birth June 18, 1922 Place of Birth West CaledoniaCounty of Queens

Name of Father Gordon Forrest MAIDEN NAME of Mother Lillian Carver

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

Residence of Father when child was born New Grafton, Queens Present address of Father New Grafton, Queens

Occupation of Father at Birth of child Labourer Place of birth of Father New Grafton, Queens

Race Name and present address of Physician in attendance at birth

Signature of Applicant Howard LeRoy Forrest Address of Applicant RR #2, Caledonia, Queens Date 18 May 1983

Relationship of Applicant to child Himself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Howard LeRoyForrest

Born at West Caledonia in the County of Queens

That Howard LeRoyForrest Whose Birth is sought to be registered was

born at West Caledonia Queens County on June 18, 1922

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

So told by my parents and as in census, National Registration & marriage record

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