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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000679

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of KatherineCampbell Sex Female

Date of Birth December 21, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father John L. Campbell MAIDEN NAME of Mother Katherine Anne MacIntosh

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

Residence of Father when child was born Glace Bay, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Blacksmith Place of birth of Father Lime Hill, Inverness

Race Name and present address of Physician in attendance at birth

Signature of Applicant Katherine MacDonald Address of Applicant 2150 Madison Avenue, Sudbury, Ontario Date 13 January 1978

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of KatherineCampbell

Born at Glace Bay in the County of Cape Breton

That KatherineCampbell Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 21, 1922

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

Certificate of baptism - Katherine Campbell baptized on October 8th, 1933 - Certificate dated December 12, 1977

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