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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000199

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gordon AllisonAdshade Sex Male

Date of Birth January 12, 1921 Place of Birth Little RiverCounty of Cumberland

Name of Father George Washington Adshade MAIDEN NAME of Mother Margaret May Faulkner

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

Residence of Father when child was born Little River Present address of Father Dever Road, Lancaster, New Brunswick

Occupation of Father at Birth of child Farmer Place of birth of Father Mansfield

Race English Name and present address of Physician in attendance at birth Dr. S.O. Salter

Signature of Applicant Margaret May Adshade Address of Applicant Dever Road, Lancaster, New Brunswick Date January 26, 1955

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gordon AllisonAdshade

Born at Little River in the County of Cumberland

That Gordon AllisonAdshade Whose Birth is sought to be registered was

born at Little River Cumberland County on January 12, 1921

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

That I am the mother of the above named Gordon Allison Adshade who was born to me at Little River Cumberland County on January 12, 1921. He was the eighth child born to me and my fourth son.

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