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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000164

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Samuel D.mSherman Sex Male

Date of Birth November 4, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Abraham Sherman MAIDEN NAME of Mother Fannie Gordon

Residence of Father when child was born Sydney, Cape Breton Co., NS Present address of Father 177 Henry Street, Sydney, Cape Breton Co., NS

Occupation of Father at Birth of child Merchant Place of birth of Father Russia

Race Name and present address of Physician in attendance at birth

Signature of Applicant Abraham Sherman Address of Applicant 177 Henry Street, Sydney, Cape Breton Co., NS Date 17 September 1941

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Samuel D.mSherman

Born at Sydney in the County of Cape Breton

That Samuel D.mSherman Whose Birth is sought to be registered was

born at Sydney Cape Breton County on November 4, 1921

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

I am his father and well remember the date of my son's birth on the day the birth occurred, I being present at home on that day.

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