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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91500465

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of James Adam RalphKirk Sex Male

Date of Birth November 23, 1923 Place of Birth AntigonishCounty of Antigonish

Name of Father James Adam Ralph Kirk MAIDEN NAME of Mother Viola Madley

Residence of Father when child was born Antigonish, NS Present address of Father Antigonish, NS

Occupation of Father at Birth of child Merchant Place of birth of Father Antigonish, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant James Adam Ralph Kirk Address of Applicant Antigonish, NS Date 28 June 1940

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of James Adam RalphKirk

Born at Antigonish in the County of Antigonish

That James Adam RalphKirk Whose Birth is sought to be registered was

born at Antigonish Antigonish County on November 23, 1923

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

As father and at home at time of birth

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