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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000455

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of LawrenceFowler Sex Male

Date of Birth September 19, 1923 Place of Birth ImperoyalCounty of Halifax

Name of Father James Fowler MAIDEN NAME of Mother Mary Rose

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

Residence of Father when child was born South Woodside Halifax Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Lawrence Fowler Address of Applicant East Chezzetcook, Halifax Co., NS Date 5 January 1973

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of LawrenceFowler

Born at Imperoyal in the County of Halifax

That LawrenceFowler Whose Birth is sought to be registered was

born at Imperoyal Halifax County on September 19, 1923

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

Certificate of Baptism

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