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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91600589

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles LawrenceAvery Sex Male

Date of Birth May 15, 1923 Place of Birth TatamagoucheCounty of Colchester

Name of Father Charles H. Avery MAIDEN NAME of Mother Elizabeth May Clark

Residence of Father when child was born White Bear, Saskatchewan Present address of Father White Bear, Saskatchewan

Occupation of Father at Birth of child Farmer Place of birth of Father Huron County, Ontario

Race Name and present address of Physician in attendance at birth

Signature of Applicant Elizabeth May Avery Address of Applicant White Bear, Saskatchewan Date 18 December 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles LawrenceAvery

Born at Tatamagouche in the County of Colchester

That Charles LawrenceAvery Whose Birth is sought to be registered was

born at Tatamagouche Colchester County on May 15, 1923

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

That I am the mother of the said Charles Lawrence Avery

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