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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000377

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John PatrickTompkins Sex Male

Date of Birth January 18, 1922 Place of Birth Margaree ForksCounty of Inverness

Name of Father Michael L. Tompkins MAIDEN NAME of Mother Virginia Doyle

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

Residence of Father when child was born Margaree Forks, Inverness Present address of Father Margaree Forks, Inverness

Occupation of Father at Birth of child Farmer Place of birth of Father Margaree Forks, Inverness

Race Name and present address of Physician in attendance at birth

Signature of Applicant Michael L. Tompkins Address of Applicant Margaree Forks, Inverness Date 3 October 1969

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John PatrickTompkins

Born at Margaree Forks in the County of Inverness

That John PatrickTompkins Whose Birth is sought to be registered was

born at Margaree Forks Inverness County on January 18, 1922

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

I am his father and living at home at time of birth

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