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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000238

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Laura ElizabethVan Buskirk Sex Female

Date of Birth January 22, 1921 Place of Birth PugwashCounty of Cumberland

Name of Father Joseph Van Buskirk MAIDEN NAME of Mother Laura White

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

Residence of Father when child was born Pugwash Present address of Father deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Pugwash

Race Dutch Name and present address of Physician in attendance at birth deceased

Signature of Applicant Mrs. Phoebe Reid Address of Applicant P.O. Box 120 Pugwash Date February 9, 1957

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Laura ElizabethVan Buskirk

Born at Pugwash in the County of Cumberland

That Laura ElizabethVan Buskirk Whose Birth is sought to be registered was

born at Pugwash Cumberland County on January 22, 1921

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

I Frank McPherson Smith provided convoyance for Laura Elizabeth Van Buskirk to the Home of her Grand Parents Mr. and Mrs. Robert White. Her mother Mrs. Joseph Van Buskirk died when Laura was born. (Baptism Certificate)

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