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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000278

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Audrey CatherineSampson Sex Female

Date of Birth March 22, 1924 Place of Birth Lower L'ArdoiseCounty of Richmond

Name of Father Albert P. Sampson MAIDEN NAME of Mother Dorothy Crawley

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

Residence of Father when child was born Lower L'Ardoise, Richmond Co., NS Present address of Father 1629 Wyondette Street West, Windsor, Ontario

Occupation of Father at Birth of child Fisherman Place of birth of Father Lower L'Ardoise, Richmond Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Audrey C. Sampson Address of Applicant 1790 Sun Valley Drive Date 21 November 1964

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Audrey CatherineSampson

Born at Lower L'Ardoise in the County of Richmond

That Audrey CatherineSampson Whose Birth is sought to be registered was

born at Lower L'Ardoise Richmond County on March 22, 1924

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

That I am the father of the said Audrey Catherine Sampson and was present at the time of the birth of the said Audrey Catherine Sampson to my lawful wife Dorothy Sampson, maiden name Crawley

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