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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92800443

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roscoe HaroldMansfield Sex Male

Date of Birth November 25, 1923 Place of Birth WestfieldCounty of Queens

Name of Father Harold Mansfield MAIDEN NAME of Mother Lettia Riley

Residence of Father when child was born Westfield, Queens Co., NS Present address of Father Westfield, Queens Co., NS

Occupation of Father at Birth of child Westfield Pulp Mill Place of birth of Father Westfield, Queens Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Harold Mansfield Address of Applicant Westfield, Queens Co., NS Date 16 November 1942

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roscoe HaroldMansfield

Born at Westfield in the County of Queens

That Roscoe HaroldMansfield Whose Birth is sought to be registered was

born at Westfield Queens County on November 25, 1923

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

That I was home at my residence the day of his birth and am sure of the date of his birth.

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