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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000290

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Robert GeraldFerguson Sex Male

Date of Birth April 8, 1923 Place of Birth ImperoyalCounty of Halifax

Name of Father Samuel H. Ferguson MAIDEN NAME of Mother Annie Louise Kempton

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

Residence of Father when child was born Imperoyal Halifax Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Mechanic Place of birth of Father Tangier, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Robert G. Ferguson Address of Applicant Milton, Queens Co., NS Date 17 July 1963

Relationship of Applicant to child Same Person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Robert GeraldFerguson

Born at Imperoyal in the County of Halifax

That Robert GeraldFerguson Whose Birth is sought to be registered was

born at Imperoyal Halifax County on April 8, 1923

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

told me by parents

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