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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000179

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Herbert ChaplinBurchell Sex Male

Date of Birth March 29, 1922 Place of Birth BridgeportCounty of Cape Breton

Name of Father Peter Burchell MAIDEN NAME of Mother Harriett Knox

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

Residence of Father when child was born Bridgeport, Cape Breton Present address of Father New Victoria, Cape Breton

Occupation of Father at Birth of child Brick Layer Place of birth of Father Sydney Mines, Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant Herbert Chaplin Burchell Address of Applicant New Victoria, Cape Breton Date July 1954

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Herbert ChaplinBurchell

Born at Bridgeport in the County of Cape Breton

That Herbert ChaplinBurchell Whose Birth is sought to be registered was

born at Bridgeport Cape Breton County on March 29, 1922

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

church records

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