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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500216

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Russell GeorgeColburn Sex Male

Date of Birth December 22, 1919 Place of Birth ShubieCounty of Cumberland

Name of Father George Henry Colburn MAIDEN NAME of Mother Adelaide Lovelock

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

Residence of Father when child was born Shulie Present address of Father

Occupation of Father at Birth of child Lumberman Place of birth of Father Nova Scotia

Race Name and present address of Physician in attendance at birth Dr. W. McLeod

Signature of Applicant Adelaide, Colburn Address of Applicant Shulie Date 22 January 1920

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Russell GeorgeColburn

Born at Shubie in the County of Cumberland

That Russell GeorgeColburn Whose Birth is sought to be registered was

born at Shubie Cumberland County on December 22, 1919

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

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