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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000343

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Murray DouglasClark Sex Male

Date of Birth June 27, 1924 Place of Birth Mount RoseCounty of Annapolis

Name of Father George Herbert Clark MAIDEN NAME of Mother Elva Healey

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

Residence of Father when child was born Mount Rose, Annapolis Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Port Lorne

Race Name and present address of Physician in attendance at birth

Signature of Applicant Murray D. Clark Address of Applicant Wilmot Station, Annapolis Co., NS Date 10 November 1970

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Murray DouglasClark

Born at Mount Rose in the County of Annapolis

That Murray DouglasClark Whose Birth is sought to be registered was

born at Mount Rose Annapolis County on June 27, 1924

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

Doctors record and school record

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