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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000500

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John FraserClark Sex Male

Date of Birth November 9, 1923 Place of Birth Kings HeadCounty of Pictou

Name of Father Albert Clark MAIDEN NAME of Mother Annie Fraser

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

Residence of Father when child was born Kings Head Pictou Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father England

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Betty Clark Address of Applicant Main Street, Trenton, Pictou Co., NS Date 25 November 1974

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John FraserClark

Born at Kings Head in the County of Pictou

That John FraserClark Whose Birth is sought to be registered was

born at Kings Head Pictou County on November 9, 1923

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

Certificate of Baptism & statement of age from Miss. Alice May Clark, sister of the applicant.

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