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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91600376

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John AllisonNewcombe Sex Male

Date of Birth October 5, 1921 Place of Birth Nappan StationCounty of Cumberland

Name of Father Burgess Newcombe MAIDEN NAME of Mother Wilhelmina Magee

Residence of Father when child was born Nappan Station, Cumberland Co., NS Present address of Father Nappan Station, Cumberland Co., NS

Occupation of Father at Birth of child Highway Employee Place of birth of Father Parrsboro, Cumberland Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Burgess Newcombe Address of Applicant Nappan Station, Cumberland Co., NS Date 20 September 1941

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John AllisonNewcombe

Born at Nappan Station in the County of Cumberland

That John AllisonNewcombe Whose Birth is sought to be registered was

born at Nappan Station Cumberland County on October 5, 1921

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

I am the mother of the above named John Allison Newcombe and as such have personal knowledge that the above facts stated are true in every particular

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