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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700713

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Laurence ArnoldLeVine Sex Male

Date of Birth May 6, 1923 Place of Birth HalifaxCounty of Halifax

Name of Father Leonard LeVine MAIDEN NAME of Mother Bessie Broder

Residence of Father when child was born Halifax, NS Present address of Father 20 1/2 Vernon Street, Halifax, NS

Occupation of Father at Birth of child Shoe Merchant Place of birth of Father Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Bessie LeVine Address of Applicant 20 1/2 Vernon Street, Halifax, NS Date 4 May 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Laurence ArnoldLeVine

Born at Halifax in the County of Halifax

That Laurence ArnoldLeVine Whose Birth is sought to be registered was

born at Halifax Halifax County on May 6, 1923

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

I am his mother and perfectly remember the date of his birth.

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