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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500029

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gladys InezChapman Sex Female

Date of Birth October 5, 1919 Place of Birth AmherstCounty of Cumberland

Name of Father Orrin Victor Chapman MAIDEN NAME of Mother Myrtle Edith Finley

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

Residence of Father when child was born Head of Amherst Present address of Father

Occupation of Father at Birth of child Farmer Place of birth of Father Chapman Settlement

Race Name and present address of Physician in attendance at birth Dr. E.P. Atkinson

Signature of Applicant Orrin Victor Chapman Address of Applicant Head of Amherst Date 19 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gladys InezChapman

Born at Amherst in the County of Cumberland

That Gladys InezChapman Whose Birth is sought to be registered was

born at Amherst Cumberland County on October 5, 1919

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

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