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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000630

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Avery HavlockUpshaw Sex Male

Date of Birth December 6, 1924 Place of Birth Three Mile PlainsCounty of Hants

Name of Father Wallace Hilton Upshaw MAIDEN NAME of Mother Sarah Havella Allison

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

Residence of Father when child was born Three Mile Plains, Hants Co., NS Present address of Father Three Mile Plains, Hants Co., NS

Occupation of Father at Birth of child Place of birth of Father Three Mile Pains Hants Three Mile Plains, Hants Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sarah Upshaw Address of Applicant Date 8 January 1925

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Avery HavlockUpshaw

Born at Three Mile Plains in the County of Hants

That Avery HavlockUpshaw Whose Birth is sought to be registered was

born at Three Mile Plains Hants County on December 6, 1924

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

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