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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000289

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Harvey St. ClairCleveland Sex Male

Date of Birth November 24, 1924 Place of Birth SomersetCounty of Kings

Name of Father Grover Cleveland MAIDEN NAME of Mother Gertrude Corkum

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

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

Occupation of Father at Birth of child Labourer Place of birth of Father South Waterville, Kings Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant H. S. Cleveland Address of Applicant 29 Pomona Avenue, Oromocto, New Brunswick Date 29 November 1965

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Harvey St. ClairCleveland

Born at Somerset in the County of Kings

That Harvey St. ClairCleveland Whose Birth is sought to be registered was

born at Somerset Kings County on November 24, 1924

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

That I am the father of Harvey St. Clair Cleveland

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