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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000934

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Vivian AgnesSampson Sex Female

Date of Birth July 19, 1924 Place of Birth StellartonCounty of Pictou

Name of Father Michael Anthony Sampson MAIDEN NAME of Mother Genevieve Andrews

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

Residence of Father when child was born Stellarton Present address of Father deceased

Occupation of Father at Birth of child Miner Place of birth of Father Hearts Desire, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Vivian Agnes Skinner (Sampson) Address of Applicant 1142 Bridge Rd. Oakville, Ontario Date February 13, 1989

Relationship of Applicant to child I am daughter of Michael Sampson

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Vivian AgnesSampson

Born at Stellarton in the County of Pictou

That Vivian AgnesSampson Whose Birth is sought to be registered was

born at Stellarton Pictou County on July 19, 1924

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

Information given to me by may parents and Certificate of Baptism dated Oct 7/1988 signed by Father Doucette of Our Lady of Lourdes Parish

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