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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000462

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Willis BernardIrwin Sex Male

Date of Birth October 14, 1923 Place of Birth Lower Jordan BayCounty of Shelburne

Name of Father John Hayes Irwin MAIDEN NAME of Mother Helen Purney

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

Residence of Father when child was born Lower Jordan Bay Shelburne Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Lower Jordan Bay, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Helen Irwin Address of Applicant RR #2, Shelburne, NS Date 7 February 1973

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Willis BernardIrwin

Born at Lower Jordan Bay in the County of Shelburne

That Willis BernardIrwin Whose Birth is sought to be registered was

born at Lower Jordan Bay Shelburne County on October 14, 1923

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

I am the mother of Willis Bernard Irwin and have full knowledge of his date of birth to being born at Lower Jordan Bay, Shelburne Co., NS on October 14th, 1923.

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