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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500202

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clarissa EdithChapman Sex Female

Date of Birth December 10, 1919 Place of Birth Chapman SettlementCounty of Cumberland

Name of Father Allan Ross Chapman MAIDEN NAME of Mother Minnie Ethelwyn Fawcett

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

Residence of Father when child was born Chapman Settlement Present address of Father

Occupation of Father at Birth of child Farmer Place of birth of Father Bayside, NB

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

Signature of Applicant Minnie Ethelwyn F. Chapman Address of Applicant Chapman Settlement Date 10 January 1920

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clarissa EdithChapman

Born at Chapman Settlement in the County of Cumberland

That Clarissa EdithChapman Whose Birth is sought to be registered was

born at Chapman Settlement Cumberland County on December 10, 1919

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

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