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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000241

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Warren LemuelKennedy Sex Male

Date of Birth October 25, 1924 Place of Birth Black RockCounty of Kings

Name of Father Clem Kennedy MAIDEN NAME of Mother Effie Brewster

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

Residence of Father when child was born Black Rock, Kings Co., NS Present address of Father

Occupation of Father at Birth of child Labourer Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Warren Kennedy Address of Applicant Nictaux, Annapolis Co., NS Date 8 December 1961

Relationship of Applicant to child Same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Warren LemuelKennedy

Born at Black Rock in the County of Kings

That Warren LemuelKennedy Whose Birth is sought to be registered was

born at Black Rock Kings County on October 25, 1924

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

1. Census records 2. Entry in register of North Kingston School, District no. 13 is in error by three days

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