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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91400059

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Catherine BeatriceBain Sex Female

Date of Birth October 3, 1922 Place of Birth New CampbelltonCounty of Victoria

Name of Father Archie Bain MAIDEN NAME of Mother Helen G. Carey

Residence of Father when child was born New Campbellton, Victoria Co., NS Present address of Father New Campbellton, Victoria Co., NS

Occupation of Father at Birth of child Miner Place of birth of Father New Campbellton, Victoria Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Archie Bain Address of Applicant New Campbellton, Victoria Co., NS Date 2 October 1941

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Catherine BeatriceBain

Born at New Campbellton in the County of Victoria

That Catherine BeatriceBain Whose Birth is sought to be registered was

born at New Campbellton Victoria County on October 3, 1922

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

That I am the father of Catherine Beatrice Bain and I was present in the home on the day the birth occurred.

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