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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000376

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Vincent MurrayPotter Sex Male

Date of Birth January 10, 1923 Place of Birth MalagashCounty of Cumberland

Name of Father Robert S. Potter MAIDEN NAME of Mother Cora Ethel Smith

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

Residence of Father when child was born Malagash Cumberland Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Fisherman's Harbour, Guysborough Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Vincent M. Potter Address of Applicant Wallace, Cumberland Co., NS Date 21 January 1970

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Vincent MurrayPotter

Born at Malagash in the County of Cumberland

That Vincent MurrayPotter Whose Birth is sought to be registered was

born at Malagash Cumberland County on January 10, 1923

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

I was a close neighbor when the above Vincent Murray Potter was born and I well remember the circumstances of his birth.

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