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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000299

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Frederick EdgarSmeltzer Sex Male

Date of Birth November 22, 1923 Place of Birth Mahone BayCounty of Lunenburg

Name of Father Harris Smeltzer MAIDEN NAME of Mother Sasie Dauphinee

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

Residence of Father when child was born Mahone Bay Lunenburg Co. Ns Present address of Father Mahone Bay, Lunenburg Co., NS

Occupation of Father at Birth of child Carpenter Place of birth of Father Mahone Bay, Lunenburg Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Harris Smeltzer Address of Applicant Mahone Bay, Lunenburg Co., NS Date 4 July 1964

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Frederick EdgarSmeltzer

Born at Mahone Bay in the County of Lunenburg

That Frederick EdgarSmeltzer Whose Birth is sought to be registered was

born at Mahone Bay Lunenburg County on November 22, 1923

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

I am the father of the said Frederick Edgar Smeltzer

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