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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000909

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy LorettaCampbell Sex Female

Date of Birth July 20, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Joseph Campbell MAIDEN NAME of Mother Mary Dalton

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dorothy Loretta Campbell Address of Applicant Agincourt, Ontario Date April 7, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy LorettaCampbell

Born at Sydney in the County of Cape Breton

That Dorothy LorettaCampbell Whose Birth is sought to be registered was

born at Sydney Cape Breton County on July 20, 1920

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

Certificate of Baptism - dated January 20, 1975 attached

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