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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91600826

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Malcolm FrederickGates Sex Male

Date of Birth June 15, 1923 Place of Birth BerwickCounty of Kings

Name of Father Frank Gates MAIDEN NAME of Mother Bertha Hiltz

Residence of Father when child was born Berwick, Kings Co., NS Present address of Father 7 Wagner Street, Peabody, Massachusetts, USA

Occupation of Father at Birth of child Farm Labourer Place of birth of Father Aylesford, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Edith M. Hiltz Address of Applicant Forties Settlement, Lunenburg Co., NS Date 22 August 1942

Relationship of Applicant to child Grandmother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Malcolm FrederickGates

Born at Berwick in the County of Kings

That Malcolm FrederickGates Whose Birth is sought to be registered was

born at Berwick Kings County on June 15, 1923

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

I was in the home at the time of birth

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