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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900936

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bertha AliceVanAmburg Sex Female

Date of Birth November 16, 1921 Place of Birth ArgyleCounty of Yarmouth

Name of Father James VanAmburg MAIDEN NAME of Mother Cynthia Shaw

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

Residence of Father when child was born Argyle, Yarmouth Co., NS Present address of Father Argyle, Yarmouth Co., NS

Occupation of Father at Birth of child Farming Place of birth of Father Argyle, Yarmouth Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Cynthia VanAmburg Address of Applicant Argyle, Yarmouth Co., NS Date 12 October 1945

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bertha AliceVanAmburg

Born at Argyle in the County of Yarmouth

That Bertha AliceVanAmburg Whose Birth is sought to be registered was

born at Argyle Yarmouth County on November 16, 1921

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

I am the mother of Bertha Alice VanAmburg

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