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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000975

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 25, 1923 Place of Birth North SydneyCounty of Cape Breton

Name of Father Edward Sampson MAIDEN NAME of Mother  Healey

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

Residence of Father when child was born North Sydney Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Rita E. Campbell Address of Applicant 976 Rankin Blvd., Windsor, Ontario, N9B 2S3 Date 4 August 1986

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at North Sydney in the County of Cape Breton

That Rita ElizabethSampson Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on May 25, 1923

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

Certificate of birth and baptism from St. Joseph's Parish, North Sydney, NS

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