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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000133

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gordon ElmerRoberts Sex Male

Date of Birth September 9, 1922 Place of Birth EurekaCounty of Pictou

Name of Father John James Robertson MAIDEN NAME of Mother Jane Campbell

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

Residence of Father when child was born Eureka, Pictou Present address of Father Not living

Occupation of Father at Birth of child Farmer Place of birth of Father Eureka, Pictou

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Jane Robertson Address of Applicant Eureka, Pictou Date 27 October 1951

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gordon ElmerRoberts

Born at Eureka in the County of Pictou

That Gordon ElmerRoberts Whose Birth is sought to be registered was

born at Eureka Pictou County on September 9, 1922

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

I am the mother of Gordon Elmer Robertson and I have examined the attending physicians records of the birth - certificate of attending physician attached hereto.

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