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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000212

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of AndrewClarke Sex Male

Date of Birth April 17, 1923 Place of Birth Glace BayCounty of Cape Breton

Name of Father Josiah Clarke MAIDEN NAME of Mother Isabella J. Clarke

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

Residence of Father when child was born Glace Bay Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Victoria, Carbonear, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Walter Clark Address of Applicant Glace Bay, Cape Breton Co., NS Date 16 March 1957

Relationship of Applicant to child Brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of AndrewClarke

Born at Glace Bay in the County of Cape Breton

That AndrewClarke Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on April 17, 1923

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

It is the date of birth shown on the attached certificate of baptism from the records of Epworth United Church, Glace Bay, Cape Breton Co., NS.

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