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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91400304

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Alfred JosephCormier Sex Male

Date of Birth July 5, 1922 Place of Birth AmherstCounty of Cumberland

Name of Father Fred Cormier MAIDEN NAME of Mother Anna Leger

Residence of Father when child was born Alma Street, Amherst, Cumberland Co., NS Present address of Father Not Living

Occupation of Father at Birth of child Coal Miner Place of birth of Father Shediac, New Brunswick

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Anna Cormier Address of Applicant 29 City Road, St. John, New Brunswick Date 29 November 1941

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Alfred JosephCormier

Born at Amherst in the County of Cumberland

That Alfred JosephCormier Whose Birth is sought to be registered was

born at Amherst Cumberland County on July 5, 1922

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

Owing to the fact that I am his mother this should prove satisfactory

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