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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000423

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Kenneth ClaytonCorkum Sex Male

Date of Birth April 3, 1923 Place of Birth West CaledoniaCounty of Queens

Name of Father Jessie Corkum MAIDEN NAME of Mother Ardis Carver

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

Residence of Father when child was born Queens County Ns Present address of Father Kempt, Queens Co., NS

Occupation of Father at Birth of child Labourer Place of birth of Father New Grafton, Queens Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Kenneth C. Corkum Address of Applicant 19 Garfield Crescent, Brampton, Ontario Date 28 September 1971

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Kenneth ClaytonCorkum

Born at West Caledonia in the County of Queens

That Kenneth ClaytonCorkum Whose Birth is sought to be registered was

born at West Caledonia Queens County on April 3, 1923

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

As advised by my mother, Ardis Corkum (nee Carver) that I was born on the 3rd day of April 1923

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