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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000168

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of George DouglasSmith Sex Male

Date of Birth December 30, 1924 Place of Birth YarmouthCounty of Yarmouth

Name of Father Douglas Minard Smith MAIDEN NAME of Mother Athalia May Duncan

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

Residence of Father when child was born Yarmouth, NS Present address of Father Yarmouth, NS

Occupation of Father at Birth of child Electrician Place of birth of Father Yarmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Douglas Minard Smith Address of Applicant Yarmouth, NS Date 16 April 1956

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of George DouglasSmith

Born at Yarmouth in the County of Yarmouth

That George DouglasSmith Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on December 30, 1924

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

Certificate from professional records of attending physician

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