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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000764

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Margaret MaySamson Sex Female

Date of Birth October 5, 1921 Place of Birth L'ArdoiseCounty of Richmond

Name of Father Simon Samson MAIDEN NAME of Mother Mary Martel

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

Residence of Father when child was born Rockdale Present address of Father L'Ardoise

Occupation of Father at Birth of child Fisherman Place of birth of Father L'Ardoise

Race Name and present address of Physician in attendance at birth

Signature of Applicant Frederick Anderson Address of Applicant 1221 Collins Ave. Ottawa, Ontario Date August 16, 1978

Relationship of Applicant to child husband

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Margaret MaySamson

Born at L'Ardoise in the County of Richmond

That Margaret MaySamson Whose Birth is sought to be registered was

born at L'Ardoise Richmond County on October 5, 1921

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

Baptismal Certificate

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