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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000071

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 3, 1924 Place of Birth DominionCounty of Cape Breton

Name of Father John W. Campbell MAIDEN NAME of Mother Mary Elizabeth McLean

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

Residence of Father when child was born Dominion, Cape Breton Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Pictou, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Elizabeth Campbell Address of Applicant Dominion, Cape Breton Co., NS Date 21 August 1948

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Dominion in the County of Cape Breton

That Rita CarmelCampbell Whose Birth is sought to be registered was

born at Dominion Cape Breton County on November 3, 1924

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

That I am the mother of the said Rita Carmel Campbell

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