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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700441

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Keith WilliamBrenton Sex Male

Date of Birth June 22, 1922 Place of Birth Middle StewiackeCounty of Colchester

Name of Father William Clarke Brenton MAIDEN NAME of Mother Irene Mae Goodwin

Residence of Father when child was born Middle Stewiacke, Colchester Co., NS Present address of Father Middle Stewiacke, Colchester Co., NS

Occupation of Father at Birth of child Farmer Place of birth of Father Middle Stewiacke, Colchester Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Agnes E. Brinton Address of Applicant 1 Pacific Street, Halifax, NS Date 3 June 1943

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Keith WilliamBrenton

Born at Middle Stewiacke in the County of Colchester

That Keith WilliamBrenton Whose Birth is sought to be registered was

born at Middle Stewiacke Colchester County on June 22, 1922

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

From memory and baptism certificate

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