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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000340

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Walter WarrenWorth Sex Male

Date of Birth December 12, 1924 Place of Birth Cross Roads Country HarbourCounty of Guysborough

Name of Father Henry Edward Worth MAIDEN NAME of Mother Sadie Jane Mason

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

Residence of Father when child was born Country Harbour, Guysborough Co., NS Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sadie Jane Worth Address of Applicant Country Harbour, Guysborough Co., NS Date 5 October 1970

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Walter WarrenWorth

Born at Cross Roads Country Harbour in the County of Guysborough

That Walter WarrenWorth Whose Birth is sought to be registered was

born at Cross Roads Country Harbour Guysborough County on December 12, 1924

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

This birth is registered in family bible

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