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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000074

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William ArchibaldKauffman Sex Male

Date of Birth January 12, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Jonathan Kauffman MAIDEN NAME of Mother Elizabeth MacNeil

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

Residence of Father when child was born Sydney Present address of Father Allentown, Pennsylvania, USA

Occupation of Father at Birth of child Hall operator Place of birth of Father Allentown, Pennsylvania, USA

Race Dutch Name and present address of Physician in attendance at birth Dr. Ray Ross

Signature of Applicant Mrs. Elizabeth Kauffman Address of Applicant 38 Armstrong Road, Sydney Date February 16, 1948

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William ArchibaldKauffman

Born at Sydney in the County of Cape Breton

That William ArchibaldKauffman Whose Birth is sought to be registered was

born at Sydney Cape Breton County on January 12, 1921

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

I am the childs mother and enclosed the Salvation Army dedication Certificate where enclosed the date and place of birth or situant being July 12, 1921 at Sydney

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