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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000356

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of David Lloyd GeorgeChapman Sex Male

Date of Birth October 15, 1923 Place of Birth HastingsCounty of Cumberland

Name of Father Lloyd Ernest Chapman MAIDEN NAME of Mother Alma Ida Manship

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

Residence of Father when child was born Hastings Cumberland Co. Ns Present address of Father Brookdale, Cumberland Co., NS

Occupation of Father at Birth of child Farmer Place of birth of Father Hastings, Cumberland Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant David L. G. Chapman Address of Applicant 5888 Sebastian Street, Halifax, NS Date 2 May 1969

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of David Lloyd GeorgeChapman

Born at Hastings in the County of Cumberland

That David Lloyd GeorgeChapman Whose Birth is sought to be registered was

born at Hastings Cumberland County on October 15, 1923

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

Baptismal certificate.

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