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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000748

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Maria DeltaSamson Sex Female

Date of Birth January 12, 1924 Place of Birth LouisdaleCounty of Richmond

Name of Father Remie Samson MAIDEN NAME of Mother Elizabeth Marchand

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

Residence of Father when child was born Louisdale, Richmond Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Louisdale, Richmond Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Delta Marie Samson Address of Applicant 127 Riverview Drive, Sydney, Cape Breton Co., NS Date 22 February 1983

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Maria DeltaSamson

Born at Louisdale in the County of Richmond

That Maria DeltaSamson Whose Birth is sought to be registered was

born at Louisdale Richmond County on January 12, 1924

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

As shown in the attached baptism certificate and indicated to me by my parents

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