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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000317

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ralph CecilAtkinson Sex Male

Date of Birth November 27, 1923 Place of Birth Lower Clarks HarbourCounty of Shelburne

Name of Father Avert Cecil Atkinson MAIDEN NAME of Mother Lena Belle Atkinson

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

Residence of Father when child was born Lower Clark's Harbour Shelburne Co. Ns Present address of Father Lower Clark's Harbour, Shelburne Co., NS

Occupation of Father at Birth of child Fisherman Place of birth of Father South Side, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Lena Atkinson Address of Applicant Lower Clark's Harbour, Shelburne Co., NS Date November 1966

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ralph CecilAtkinson

Born at Lower Clarks Harbour in the County of Shelburne

That Ralph CecilAtkinson Whose Birth is sought to be registered was

born at Lower Clarks Harbour Shelburne County on November 27, 1923

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

I am the mother of this person and have lived in the same house with him since birth to the present time.

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