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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000387

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Vance EdsonSmith Sex Male

Date of Birth July 11, 1923 Place of Birth Broad CoveCounty of Lunenburg

Name of Father Roy Lemuel Smith MAIDEN NAME of Mother Mildred Victoria Conrad

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

Residence of Father when child was born Broad Cove Lunenburg Co. Ns Present address of Father Broad Cove, Lunenburg Co., NS

Occupation of Father at Birth of child Fisherman Place of birth of Father Broad Cove, Lunenburg Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Florence A. Smith Address of Applicant 6573 Bayers Road, Halifax, NS Date 26 May 1970

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Vance EdsonSmith

Born at Broad Cove in the County of Lunenburg

That Vance EdsonSmith Whose Birth is sought to be registered was

born at Broad Cove Lunenburg County on July 11, 1923

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

Baptismal certificate

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