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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

36800319

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Smith Sex

Date of Birth August 13, 1924 Place of Birth Kelleys CoveCounty of Yarmouth

Name of Father Bradford Smith MAIDEN NAME of Mother Mable Rogers

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

Residence of Father when child was born Kelley's Cove, Yarmouth Co., NS Present address of Father

Occupation of Father at Birth of child Fishing Place of birth of Father Cape Sable Island, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Bradford Smith Address of Applicant Kelley's Cove, Yarmouth Co., NS Date 13 August 1924

Relationship of Applicant to child Father

AFFIDAVIT

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

Born at Kelleys Cove in the County of Yarmouth

That Smith Whose Birth is sought to be registered was

born at Kelleys Cove Yarmouth County on August 13, 1924

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

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