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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900539

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of George RichardBenham Sex Male

Date of Birth September 19, 1921 Place of Birth LockeportCounty of Shelburne

Name of Father George Albert Benham MAIDEN NAME of Mother Harriet Louise Laing

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Lockeport, Shelburne Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Captain Place of birth of Father Lockeport, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Harriett Louise Benham Address of Applicant Lockeport, Shelburne Co., NS Date 18 June 1945

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of George RichardBenham

Born at Lockeport in the County of Shelburne

That George RichardBenham Whose Birth is sought to be registered was

born at Lockeport Shelburne County on September 19, 1921

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

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