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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600313

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Henery JohnKelly Sex Male

Date of Birth October 23, 1922 Place of Birth KentvilleCounty of Kings

Name of Father Walter Seymour Kelly MAIDEN NAME of Mother Harriett Essie Kelly

Residence of Father when child was born Kentville, Kings Co., NS Present address of Father Kentville, Kings Co., NS

Occupation of Father at Birth of child Painter Place of birth of Father Grand Pre, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Walter Kelly Address of Applicant Kentville, Kings Co., NS Date 17 November 1934

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Henery JohnKelly

Born at Kentville in the County of Kings

That Henery JohnKelly Whose Birth is sought to be registered was

born at Kentville Kings County on October 23, 1922

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

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