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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100219

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary LouiseCampbell Sex Female

Date of Birth April 28, 1921 Place of Birth Bear RiverCounty of Annapolis

Name of Father Arthur Thomas Campbell MAIDEN NAME of Mother Elsie Mae Allison

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

Residence of Father when child was born Bear River Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary L. Dulac Address of Applicant 8 Old Melford Rd. Brookline, New Hampshire, USA Date September 6, 1991

Relationship of Applicant to child same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary LouiseCampbell

Born at Bear River in the County of Annapolis

That Mary LouiseCampbell Whose Birth is sought to be registered was

born at Bear River Annapolis County on April 28, 1921

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

Cradle Roll Marriage Certificate Church Record

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