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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91600701

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rowland RoyCoates Sex Male

Date of Birth September 23, 1921 Place of Birth 165 Pleasant Street East, AmehrstCounty of Cumberland

Name of Father Roy Botsford Coates MAIDEN NAME of Mother Clara Mae Roach

Residence of Father when child was born Amherst, Cumberland Co., NS Present address of Father 160 Church Street, Amherst, Cumberland Co., NS

Occupation of Father at Birth of child Vulcanizer Place of birth of Father Amherst, Cumberland Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Roy B. Coates Address of Applicant 160 Church Street, Amherst, Cumberland Co., NS Date 1 September 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rowland RoyCoates

Born at 165 Pleasant Street East, Amehrst in the County of Cumberland

That Rowland RoyCoates Whose Birth is sought to be registered was

born at 165 Pleasant Street East, Amehrst Cumberland County on September 23, 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 Rowland Roy Coates and as such have personal knowledge that the above facts are true in every particular.

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