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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500609

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Elmer DeweyNickerson Sex Male

Date of Birth November 23, 1922 Place of Birth RockvilleCounty of Yarmouth

Name of Father Dewey Walton Nickerson MAIDEN NAME of Mother Jeanette Gertrude Smith

Residence of Father when child was born Rockville Present address of Father Rockville

Occupation of Father at Birth of child Fisherman Place of birth of Father Cape Sable Island

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dewey W. Nickerson Address of Applicant Rockville Date July 23, 1940

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Elmer DeweyNickerson

Born at Rockville in the County of Yarmouth

That Elmer DeweyNickerson Whose Birth is sought to be registered was

born at Rockville Yarmouth County on November 23, 1922

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

I was in the house at the time of birth and am the father of Elmer Dewey Nickerson and also have certificate of Dr. Chas. K. Fuller, the attending physician.

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