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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000276

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Alexander CampbellColeman Sex

Date of Birth September 15, 1920 Place of Birth SpringhillCounty of Cumberland

Name of Father   MAIDEN NAME of Mother Annie Coleman

Were the Parents married at the time of the Birth?

Residence of Father when child was born Present address of Father

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

Race White Name and present address of Physician in attendance at birth R.R. Withrow, M.D., Springhill

Signature of Applicant Annie Coleman Address of Applicant Springhill Date June 7, 1957

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Alexander CampbellColeman

Born at Springhill in the County of Cumberland

That Alexander CampbellColeman Whose Birth is sought to be registered was

born at Springhill Cumberland County on September 15, 1920

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

I am the mother of Alexander Campbell Coleman and as such have full knowledge of the birth as having taken place on Sept. 15, 1920

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