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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100088

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 10, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father John Campbell MAIDEN NAME of Mother Elizabeth Jane White

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 Coal Miner Place of birth of Father Big Pond

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dorothy G. Pate Address of Applicant 1323 Birmingham St. Halifax Date March 12, 1985

Relationship of Applicant to child Sister

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That Michael JohnCampbell Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 10, 1921

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

Certificate of Baptism from St. Anne's Parish Glace Bay, C.B.

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