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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000447

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Kenneth WarrenBlack Sex Male

Date of Birth December 3, 1924 Place of Birth BrookdaleCounty of Cumberland

Name of Father Warren Culler Black MAIDEN NAME of Mother Alice Jane Chappell

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

Residence of Father when child was born Brookdale, Cumberland Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Salem, Cumberland Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Alice Jane Black Address of Applicant 109 Victoria Street, Amherst, Cumberland Co., NS Date 14 November 1974

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Kenneth WarrenBlack

Born at Brookdale in the County of Cumberland

That Kenneth WarrenBlack Whose Birth is sought to be registered was

born at Brookdale Cumberland County on December 3, 1924

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

I qave birth to him at the home occupied by Warren Culler Black and me. I clearly remember the occasion. Dr. Goodwin, long deceased, then of Amherst, delivered, assisted by midwife Mrs. Sarah Bent, long deceased, then of Brookdale. Celebration has always been December 3.

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