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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000824

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Russell JamesStubbert Sex Male

Date of Birth July 11, 1921 Place of Birth Alder PointCounty of Cape Breton

Name of Father   MAIDEN NAME of Mother Maud Stubbert

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Russell James Stubbert Address of Applicant Alder Point Date April 19, 1979

Relationship of Applicant to child one and same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Russell JamesStubbert

Born at Alder Point in the County of Cape Breton

That Russell JamesStubbert Whose Birth is sought to be registered was

born at Alder Point Cape Breton County on July 11, 1921

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

1. Certificate of Birth and Baptism, enclosed

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