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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000186

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gertrude HenriettaSampson Sex Female

Date of Birth August 22, 1922 Place of Birth LouisdaleCounty of Richmond

Name of Father Joseph Felix Sampson MAIDEN NAME of Mother Mary Obellin Sampson

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

Residence of Father when child was born Louisdale, Richmond Present address of Father Louisdale, Richmond

Occupation of Father at Birth of child Fisherman Place of birth of Father Sampson Cove, Richmond

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Obellin Sampson Address of Applicant Louisdale, Richmond Date 26 August 1954

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gertrude HenriettaSampson

Born at Louisdale in the County of Richmond

That Gertrude HenriettaSampson Whose Birth is sought to be registered was

born at Louisdale Richmond County on August 22, 1922

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

My knowledge is that I have all the names of my children and the dates they were all born in a book I have. (church records)

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