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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000472

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 24, 1923 Place of Birth AfricvilleCounty of Halifax

Name of Father Samuel Brown MAIDEN NAME of Mother Muriel Clayton

Were the Parents married at the time of the Birth? No

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

Occupation of Father at Birth of child Seaman Place of birth of Father Africville, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant William Clayton Address of Applicant 3526 Barrington Street, Halifax, NS Date 30 November 1961

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Africville in the County of Halifax

That WilliamClayton Whose Birth is sought to be registered was

born at Africville Halifax County on December 24, 1923

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

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