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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000352

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Addie RebeccaVan Amburg Sex Female

Date of Birth September 27, 1921 Place of Birth ArgyleCounty of Yarmouth

Name of Father James Van Amburg MAIDEN NAME of Mother Cynthia Mae Shaw

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

Residence of Father when child was born Argyle Present address of Father Albany

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

Race English Name and present address of Physician in attendance at birth

Signature of Applicant Edna S. Brown Address of Applicant Middleton Date April 18, 1966

Relationship of Applicant to child None

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Addie RebeccaVan Amburg

Born at Argyle in the County of Yarmouth

That Addie RebeccaVan Amburg Whose Birth is sought to be registered was

born at Argyle Yarmouth County on September 27, 1921

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

Copy family Bible Entries showing births of 10 children of James Van Amburg and his wife Cynthia Mae Van Amburg "Addie Rebecca" born Sept 27th 1921 and attached Dominion Bureau Statistics Letter dated March 23, 1966 addressed to Mrs. Addie Davis

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