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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90501463

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Agnes ClarissaKing Sex Female

Date of Birth February 7, 1920 Place of Birth Glace BayCounty of Cape Breton

Name of Father Augustus King MAIDEN NAME of Mother Winnie Gilliard

Residence of Father when child was born Glace Bay, Cape Breton County Present address of Father deceased

Occupation of Father at Birth of child Coal Mineer Place of birth of Father Glace Bay, Cape Breton County

Race Canadian Name and present address of Physician in attendance at birth Dr. F. G. McAskill, Glace Bay

Signature of Applicant Andrew Gilliard Address of Applicant 12 Minto Street, Glace Bay Date 14 February 1940

Relationship of Applicant to child Grandfather

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Agnes ClarissaKing

Born at Glace Bay in the County of Cape Breton

That Agnes ClarissaKing Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on February 7, 1920

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

I am the grandfather of the said Agnes Clarice King and I have personal knowledge of the date of her birth. Her mother who is my daughter was living with me when Agnes Clarice King was born.

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