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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000178

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Wilbert GarfieldBenjamin Sex Male

Date of Birth August 17, 1924 Place of Birth Scots Bay RoadCounty of Kings

Name of Father Norman Benjamin MAIDEN NAME of Mother Frances Schofield

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

Residence of Father when child was born Scots Bay Road, Kings Co., NS Present address of Father Burlington, Kings Co., NS

Occupation of Father at Birth of child Farmer Place of birth of Father Scots Bay Road, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Wilbert Garfield Benjamin Address of Applicant Burlington, Kings Co., NS Date 7 September 1956

Relationship of Applicant to child Same Person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Wilbert GarfieldBenjamin

Born at Scots Bay Road in the County of Kings

That Wilbert GarfieldBenjamin Whose Birth is sought to be registered was

born at Scots Bay Road Kings County on August 17, 1924

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

Family tradition and school record National registration

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