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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000160

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rita CarmelCampbell Sex Female

Date of Birth November 26, 1923 Place of Birth Bridgeport Glace BayCounty of Cape Breton

Name of Father Dan Campbell MAIDEN NAME of Mother Annie Casey

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

Residence of Father when child was born Bridgeport Glace Bay Cape Breton Co. Ns Present address of Father 251 Main Street, Glace Bay, Cape Breton Co., NS

Occupation of Father at Birth of child Mechanic Place of birth of Father Bridgeport, Glace Bay, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Annie Campbell Address of Applicant Glace Bay, Cape Breton Co., NS Date 22 April 1953

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rita CarmelCampbell

Born at Bridgeport Glace Bay in the County of Cape Breton

That Rita CarmelCampbell Whose Birth is sought to be registered was

born at Bridgeport Glace Bay Cape Breton County on November 26, 1923

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

I am her mother and recall the circumstances quite well.

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