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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92800601

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roy JohnSmith Sex Male

Date of Birth August 22, 1921 Place of Birth PockwockCounty of Halifax

Name of Father Thomas Hedley Smith MAIDEN NAME of Mother Fannie Langille

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

Occupation of Father at Birth of child Lumber Mill Worker Place of birth of Father English Corner, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Fannie Langille Smith Address of Applicant Pockwock, Halifax Co., NS Date 4 December 1944

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roy JohnSmith

Born at Pockwock in the County of Halifax

That Roy JohnSmith Whose Birth is sought to be registered was

born at Pockwock Halifax County on August 22, 1921

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

I, Fannie Langille Smith am the mother of Roy John Smith.

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