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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000173

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ruby AlicePotter Sex Female

Date of Birth May 7, 1923 Place of Birth ClementsvaleCounty of Annapolis

Name of Father Earl C. Potter MAIDEN NAME of Mother Alice May Martin

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Clementsvale Present address of Father

Occupation of Father at Birth of child Farmer Place of birth of Father Clementsvale

Race Name and present address of Physician in attendance at birth

Signature of Applicant Earl Potter Address of Applicant Clementsvale Date 17 Mary 1923

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ruby AlicePotter

Born at Clementsvale in the County of Annapolis

That Ruby AlicePotter Whose Birth is sought to be registered was

born at Clementsvale Annapolis County on May 7, 1923

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

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