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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000944

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Russell BenjaminDorey Sex Male

Date of Birth July 2, 1922 Place of Birth New CornwallCounty of Lunenburg

Name of Father Daniel Dorey MAIDEN NAME of Mother Mary Alice Bruhm

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

Residence of Father when child was born New Cornwall, Lunenburg Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Clearland, Lunenburg

Race Name and present address of Physician in attendance at birth

Signature of Applicant Russell B. Dorey Address of Applicant RR #2, Mahone Bay, Lunenburg Date 21 July 1983

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Russell BenjaminDorey

Born at New Cornwall in the County of Lunenburg

That Russell BenjaminDorey Whose Birth is sought to be registered was

born at New Cornwall Lunenburg County on July 2, 1922

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

Baptism

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