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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90800638

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of David AlexanderGass Sex Male

Date of Birth February 12, 1922 Place of Birth AmherstCounty of Cumberland

Name of Father Charles Leon Gass MAIDEN NAME of Mother Jean Emeline MacGregor

Residence of Father when child was born Amherst Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jean E. Gass Address of Applicant Sackville, New Brunswick Date 13 May 1937

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of David AlexanderGass

Born at Amherst in the County of Cumberland

That David AlexanderGass Whose Birth is sought to be registered was

born at Amherst Cumberland County on February 12, 1922

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

I am the mother of the above named David Alexander Gass.

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