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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000534

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Edward GerrardSamson Sex Male

Date of Birth May 14, 1922 Place of Birth L'ArdoiseCounty of Richmond

Name of Father Albini Samson MAIDEN NAME of Mother Rose Prejean

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

Residence of Father when child was born L'Ardoise, Richmond Present address of Father Deceeased

Occupation of Father at Birth of child Farmer Place of birth of Father L'Ardoise, Richmond

Race Name and present address of Physician in attendance at birth

Signature of Applicant F. V. Jones Carrier Address of Applicant Halifax Date 16 April 1975

Relationship of Applicant to child Sister in Law

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Edward GerrardSamson

Born at L'Ardoise in the County of Richmond

That Edward GerrardSamson Whose Birth is sought to be registered was

born at L'Ardoise Richmond County on May 14, 1922

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

Baptismal.

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