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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900521

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Carl WendellAllen Sex Male

Date of Birth September 25, 1921 Place of Birth AmherstCounty of Cumberland

Name of Father Charles Chapell Allen MAIDEN NAME of Mother Amy Pearson

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

Occupation of Father at Birth of child Labourer Place of birth of Father Baie Side, New Brunswick

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Amy Allen Address of Applicant 3 Fairview Avenue, Amherst, Cumberland Co., NS Date 20 September 1945

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Carl WendellAllen

Born at Amherst in the County of Cumberland

That Carl WendellAllen Whose Birth is sought to be registered was

born at Amherst Cumberland County on September 25, 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 Carl Wendell Allen and so such have personal knowledge that the facts here is stated are true in every particular.

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