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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700449

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of James AmosBugley Sex Male

Date of Birth June 4, 1923 Place of Birth TidnishCounty of Cumberland

Name of Father Amos Higgins Bugley MAIDEN NAME of Mother Mary Chase

Residence of Father when child was born Tidnish, Cumberland Co., NS Present address of Father Tidnish, Cumberland Co., NS

Occupation of Father at Birth of child Carpenter Place of birth of Father Tidnish, Cumberland Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Amos H. Bugley Address of Applicant Tidnish, Cumberland Co., NS Date 6 March 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of James AmosBugley

Born at Tidnish in the County of Cumberland

That James AmosBugley Whose Birth is sought to be registered was

born at Tidnish Cumberland County on June 4, 1923

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

I am the mother of James Amos Bugley and as such, have personal knowledge that the above facts as stated ate true in every particular.

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