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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600967

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Leslie GrantRogers Sex Male

Date of Birth February 21, 1922 Place of Birth WolfvilleCounty of Kings

Name of Father Howard Rogers MAIDEN NAME of Mother Viola Grace Rogers

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

Occupation of Father at Birth of child Labourer Place of birth of Father Wolfville, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Howard Rogers Address of Applicant Wolfville, Kings Co., NS Date 21 October 1937

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Leslie GrantRogers

Born at Wolfville in the County of Kings

That Leslie GrantRogers Whose Birth is sought to be registered was

born at Wolfville Kings County on February 21, 1922

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

I declare this to be a true statement

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