| What is the full name of child? | Chapman, Gilbert |
| When was the child born? | April 12 1810 |
| Where was the child born? | 48 John |
| Male or Female | M |
| Are the parents married? | Yes |
| Full name of Father | John Edward Chapman |
| Occupation of Father? | Car repairer |
| Full Maiden Name of Mother | Eliza Ann Foster |
| If she has been more than once married give names of former husband, or husbands | no |
| Where were the parents married? | Toronto Ont |
| When were they married? | July 20 1907 |
| If not married give full Name of Mothe | |
| Is she single or a Widow? | |
| What is her occupation? | |
| Name of Physician attending | Dr Marlatt |
| Your relation to child | Father |
| Were you in house at time of Birth? | no |
| Certified by | John Ed Chapman |
| Address | 48 John St |
| Date | |
| Remarks | April 16 April [sic] |
Source: Archives of Ontario; Series: MS929; Reel: 209
Source: Ancestry.com. Ontario, Canada Births, 1869-1913