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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000577

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth August 20, 1923 Place of Birth PrestonCounty of Halifax

Name of Father James Alex Colley MAIDEN NAME of Mother Harriett Diggs

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

Residence of Father when child was born East Preston Halifax Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father East Preston, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Samuel Colley Address of Applicant East Preston, Halifax Co., NS Date 13 September 1976

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Preston in the County of Halifax

That SamuelColley Whose Birth is sought to be registered was

born at Preston Halifax County on August 20, 1923

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

National Registration Census Records

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