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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000524

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clinton AllisonTravis Sex Male

Date of Birth August 30, 1923 Place of Birth North WoodsideCounty of Halifax

Name of Father William Thomas Travis MAIDEN NAME of Mother Gladys Victoria Grogett

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

Residence of Father when child was born North Woodside Present address of Father deceased

Occupation of Father at Birth of child Labour Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant C.A. Travis Address of Applicant 11686 98th Ave. Surrey, British Columbia Date June 2, 1972

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clinton AllisonTravis

Born at North Woodside in the County of Halifax

That Clinton AllisonTravis Whose Birth is sought to be registered was

born at North Woodside Halifax County on August 30, 1923

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

Army records Marriage records School records

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