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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000016

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Thomas GordonRaynard Sex Male

Date of Birth May 18, 1922 Place of Birth Tusket FallsCounty of Yarmouth

Name of Father Watson Raynard MAIDEN NAME of Mother Annie Need Gavel

Residence of Father when child was born Tusket Falls, Yarmouth Co., NS Present address of Father Tusket Falls, Yarmouth Co., NS

Occupation of Father at Birth of child Farmer Place of birth of Father Tusket Falls, Yarmouth Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Annie W. Raynard Address of Applicant Tusket Falls, Yarmouth Co., NS Date 22 January 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Thomas GordonRaynard

Born at Tusket Falls in the County of Yarmouth

That Thomas GordonRaynard Whose Birth is sought to be registered was

born at Tusket Falls Yarmouth County on May 18, 1922

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

I am the mother of Thomas Gordon Raynard and do well remember the date of his birth

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