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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600336

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Leveret LovellWarren Sex Male

Date of Birth April 24, 1923 Place of Birth BridgewaterCounty of Lunenburg

Name of Father Lovell Warren MAIDEN NAME of Mother Martha Whynacht

Residence of Father when child was born Bridgewater, Lunenburg Co., NS Present address of Father

Occupation of Father at Birth of child Engine Cleaner Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Martha Riley Address of Applicant Roxbury, Massachusetts, USA Date 3 July 1933

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Leveret LovellWarren

Born at Bridgewater in the County of Lunenburg

That Leveret LovellWarren Whose Birth is sought to be registered was

born at Bridgewater Lunenburg County on April 24, 1923

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

Verification from records of Deputy Registrar Generals Office attached

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