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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92800255

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Edward RaymondHines Sex Male

Date of Birth December 4, 1920 Place of Birth DartmouthCounty of Halifax

Name of Father Edward Hines MAIDEN NAME of Mother Cecilia Faulkner

Residence of Father when child was born Dartmouth, NS Present address of Father Woodside, Halifax Co., NS

Occupation of Father at Birth of child Employee Imperial Oil Place of birth of Father Port Dufferin, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant F.R. Hines Address of Applicant Woodside, Halifax Co., NS Date September 2, 1944

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Edward RaymondHines

Born at Dartmouth in the County of Halifax

That Edward RaymondHines Whose Birth is sought to be registered was

born at Dartmouth Halifax County on December 4, 1920

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

Baptismal Certificate attached

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