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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000532

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Michael BernardCampbell Sex Male

Date of Birth August 16, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Murdock Campbell MAIDEN NAME of Mother Mary E. Pepper

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

Residence of Father when child was born Glace Bay Present address of Father deceased

Occupation of Father at Birth of child Boiler Maker Place of birth of Father Cape Breton County

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

Signature of Applicant M.B. Campbell Address of Applicant 1 Princess St. Glace Bay Date November 15, 1973

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Michael BernardCampbell

Born at Glace Bay in the County of Cape Breton

That Michael BernardCampbell Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on August 16, 1921

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

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