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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000777

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Malcolm LawrenceHubley Sex Male

Date of Birth December 11, 1924 Place of Birth Port MedwayCounty of Queens

Name of Father   MAIDEN NAME of Mother Gladys Hubley

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Malcolm Hubley Address of Applicant PO Box 11, Port Medway, Queens Co., NS Date March 1984

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Malcolm LawrenceHubley

Born at Port Medway in the County of Queens

That Malcolm LawrenceHubley Whose Birth is sought to be registered was

born at Port Medway Queens County on December 11, 1924

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

I have an order of his Honour Judge Lester L. Clements, Judge of the County of Court for District Number Two, finding that I was born on December 11, 1924

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