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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000544

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gordon AlexanderCampbell Sex Male

Date of Birth August 3, 1920 Place of Birth ScotsburnCounty of Pictou

Name of Father George Gordon Campbell MAIDEN NAME of Mother Charlotte Julia Schafte

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

Residence of Father when child was born Pictou County Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Pictou County

Race White Name and present address of Physician in attendance at birth

Signature of Applicant Janet M. Campbell Address of Applicant Scotsburn Date April 13, 1971

Relationship of Applicant to child Aunt

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gordon AlexanderCampbell

Born at Scotsburn in the County of Pictou

That Gordon AlexanderCampbell Whose Birth is sought to be registered was

born at Scotsburn Pictou County on August 3, 1920

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

1. Baptism Certificate 2. Certificate based on entry in Family Bible

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