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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90701088

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Madeline ClaraWournell Sex Female

Date of Birth June 19, 1920 Place of Birth Tufts CoveCounty of Halifax

Name of Father Walter Wournell MAIDEN NAME of Mother Clara Marion Tufts

Residence of Father when child was born Tufts Cove, Dartmouth, Halifax Co. Present address of Father Tufts Cove, Dartmouth, Halifax Co.

Occupation of Father at Birth of child Railway Brakeman Place of birth of Father Halifax

Race White Name and present address of Physician in attendance at birth Miss. Connors, midwife

Signature of Applicant Walter Wournell Address of Applicant Tufts Cove, Dartmouth, Halifax Co. Date 19 August 1936

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Madeline ClaraWournell

Born at Tufts Cove in the County of Halifax

That Madeline ClaraWournell Whose Birth is sought to be registered was

born at Tufts Cove Halifax County on June 19, 1920

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

I am her father

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