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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700388

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roger AugustineYoung Sex Male

Date of Birth November 9, 1921 Place of Birth East DalhousieCounty of Kings

Name of Father David Walter Young MAIDEN NAME of Mother Ida Mary Smith

Residence of Father when child was born East Dalhousie, Kings Co., NS Present address of Father East Dalhousie, Kings Co., NS

Occupation of Father at Birth of child Sawyer Place of birth of Father Clearland, Lunenburg Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Ida Mary Young Address of Applicant East Dalhousie, Kings Co., NS Date 17 October 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roger AugustineYoung

Born at East Dalhousie in the County of Kings

That Roger AugustineYoung Whose Birth is sought to be registered was

born at East Dalhousie Kings County on November 9, 1921

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

I am the mother of Roger Augustine Young and I well remember the date of his birth.

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