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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000361

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Warren EdwardWagner Sex Male

Date of Birth July 12, 1920 Place of Birth Harmony MillsCounty of Queens

Name of Father Naaman Wagner MAIDEN NAME of Mother Bessie Blanch Weagle

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

Residence of Father when child was born Harmony Mills, Queens Co. Present address of Father Caledonia, Queens Co.

Occupation of Father at Birth of child Pulp Mill Worker Place of birth of Father New Canada, Lunenburg Co.

Race Anglo Saxon Name and present address of Physician in attendance at birth Dr. A. C. McLeod, Caledonia, Queens Co.

Signature of Applicant Warren Edward Wagner Address of Applicant 42 Old Sambro Road, Spryfield, Halifax Co Date 3 May 1962

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Warren EdwardWagner

Born at Harmony Mills in the County of Queens

That Warren EdwardWagner Whose Birth is sought to be registered was

born at Harmony Mills Queens County on July 12, 1920

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

I am his father and enclosed herewith certificate of the attending physician Dr. A. C. McLeod

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