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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500773

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Victor HeckmanGould Sex Male

Date of Birth November 4, 1921 Place of Birth CannanCounty of Yarmouth

Name of Father William Heckman Gould MAIDEN NAME of Mother Margaret White

Residence of Father when child was born Cannan Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Wellington

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Margaret Atkinson Address of Applicant King St. Yarmouth Date December 3, 1940

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Victor HeckmanGould

Born at Cannan in the County of Yarmouth

That Victor HeckmanGould Whose Birth is sought to be registered was

born at Cannan Yarmouth County on November 4, 1921

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

I am the mother of Victor Heckman Gould and do well remember the date of his birth

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