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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100032

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clifford CyrilSmith Sex Male

Date of Birth March 29, 1922 Place of Birth SambroCounty of Halifax

Name of Father John Michael Smith MAIDEN NAME of Mother Hilda Leona Gilkie

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

Residence of Father when child was born Sambro, Halifax Present address of Father Deceased, March 30, 1979

Occupation of Father at Birth of child Engineer Place of birth of Father Sambro, Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Cyril Clifford Smith Address of Applicant RR #2, Orillia, Ontario Date 6 January 1986

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clifford CyrilSmith

Born at Sambro in the County of Halifax

That Clifford CyrilSmith Whose Birth is sought to be registered was

born at Sambro Halifax County on March 29, 1922

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

Certificate of Baptism, a copy of which is attached as Exhibit "A" and the oral confirmation of my mother

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