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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100094

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Laurie AllisonAnderson Sex Male

Date of Birth November 10, 1923 Place of Birth Musquodoboit HarbourCounty of Halifax

Name of Father Charles William Anderson MAIDEN NAME of Mother Nellie Florence Kiezer

Residence of Father when child was born Musquodoboit Harbour Present address of Father deceased

Occupation of Father at Birth of child Engineer Place of birth of Father West Petpeswick

Race Name and present address of Physician in attendance at birth

Signature of Applicant Nellie Anderson Young Address of Applicant St. Catherines, Ontario Date January 22, 1936

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Laurie AllisonAnderson

Born at Musquodoboit Harbour in the County of Halifax

That Laurie AllisonAnderson Whose Birth is sought to be registered was

born at Musquodoboit Harbour Halifax County on November 10, 1923

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

Mother of child

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