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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000420

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William ThomasSemple Sex Male

Date of Birth January 17, 1920 Place of Birth StellartonCounty of Pictou

Name of Father Frank Semple MAIDEN NAME of Mother Elizabeth May Dailey

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

Residence of Father when child was born Stellarton Present address of Father deceased

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

Race Scottish Name and present address of Physician in attendance at birth Dr. R.M. Benvie, Stellarton

Signature of Applicant Elizabeth Semple Address of Applicant Willowdale, Ontario Date November 17, 1965

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William ThomasSemple

Born at Stellarton in the County of Pictou

That William ThomasSemple Whose Birth is sought to be registered was

born at Stellarton Pictou County on January 17, 1920

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

Baptismal Certificate issued from Sharon-St. John Church, Stellarton, which records the name of the parents of William Thomas Semple to be Frank and Elizabeth Semple. In recording this baptismal, it appears the error was made in the spelling of the surname. The correct spelling is Semple. This is the name under which we have always been known.

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