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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000737

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John DavidGraham Sex Male

Date of Birth January 9, 1922 Place of Birth BelmontCounty of Colchester

Name of Father David Selden Graham MAIDEN NAME of Mother Ethel May Berry

Residence of Father when child was born Belmont, Colchester Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Belmont, Colchester Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ethel May Graham Address of Applicant Belmont, Colchester Co., NS Date 25 October 1941

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John DavidGraham

Born at Belmont in the County of Colchester

That John DavidGraham Whose Birth is sought to be registered was

born at Belmont Colchester County on January 9, 1922

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

I am his mother

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