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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000755

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Robert FrederickClarke Sex Male

Date of Birth November 14, 1924 Place of Birth FlorenceCounty of Cape Breton

Name of Father Simon Clarke MAIDEN NAME of Mother Louise Croft

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

Residence of Father when child was born Florence, Cape Breton Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Shirley Clark Address of Applicant Box 16, Tucker Lake, RR #1, Lower Sackville, Halifax Co., NS Date 29 June 1983

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Robert FrederickClarke

Born at Florence in the County of Cape Breton

That Robert FrederickClarke Whose Birth is sought to be registered was

born at Florence Cape Breton County on November 14, 1924

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

Marriage extract School record National registration Record from Salvation Army

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