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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000624

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of MalcolmEllsworth Sex

Date of Birth March 27, 1920 Place of Birth North SydneyCounty of Cape Breton

Name of Father Mesheck Ellsworth MAIDEN NAME of Mother Annie Hatcher

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

Residence of Father when child was born North Sydney Present address of Father

Occupation of Father at Birth of child Labourer Place of birth of Father Newfoundland

Race English Name and present address of Physician in attendance at birth Dr. W.J. McLean

Signature of Applicant Annie Ellsworth Address of Applicant Date

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of MalcolmEllsworth

Born at North Sydney in the County of Cape Breton

That MalcolmEllsworth Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on March 27, 1920

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

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