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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000636

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Carl VictorCleveland Sex Male

Date of Birth November 22, 1924 Place of Birth HalifaxCounty of Halifax

Name of Father Aden Ernest Cleveland MAIDEN NAME of Mother Olive Myra

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

Residence of Father when child was born Creighton Street, Halifax, NS Present address of Father Deceased

Occupation of Father at Birth of child Longshoreman Place of birth of Father West Dover, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Carl V. Cleveland Address of Applicant 2810 East 2nd Avenue, Vancouver, BC Date 4 July 1979

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Carl VictorCleveland

Born at Halifax in the County of Halifax

That Carl VictorCleveland Whose Birth is sought to be registered was

born at Halifax Halifax County on November 22, 1924

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

Baptismal certificate School record Marriage extract

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