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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000431

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarence BernardKelly Sex Male

Date of Birth February 3, 1923 Place of Birth HalifaxCounty of Halifax

Name of Father William Bernard Kelly MAIDEN NAME of Mother Pansy Rolfe

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

Residence of Father when child was born Halifax Ns Present address of Father Halifax, NS

Occupation of Father at Birth of child Office Clerk Place of birth of Father Halifax, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Clarence B. Kelly Address of Applicant 2895 George Dauphinee Avenue, Halifax, NS Date 19 April 1972

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarence BernardKelly

Born at Halifax in the County of Halifax

That Clarence BernardKelly Whose Birth is sought to be registered was

born at Halifax Halifax County on February 3, 1923

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

Baptismal Certificate

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