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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500837

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of AshtonScoville Sex Male

Date of Birth July 5, 1922 Place of Birth YarmouthCounty of Yarmouth

Name of Father Clifford Scoville MAIDEN NAME of Mother Leah Crosby

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

Occupation of Father at Birth of child Helper in Burrell Johnson Machine Shop Place of birth of Father Pembroke

Race Name and present address of Physician in attendance at birth

Signature of Applicant Clifford Scoville Address of Applicant Yarmouth Date February 28, 1941

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of AshtonScoville

Born at Yarmouth in the County of Yarmouth

That AshtonScoville Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on July 5, 1922

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

I am the Father of Ashton Scoville. I was at home when he was born and do well remember the date of his birth

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