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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000723

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 1, 1920 Place of Birth ReserveCounty of Cape Breton

Name of Father Alex LeBlanc MAIDEN NAME of Mother Mary Ann Roach

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

Residence of Father when child was born Reserve Present address of Father deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Cheticamp

Race Name and present address of Physician in attendance at birth

Signature of Applicant Agnes Rita LeBlanc Address of Applicant Reserve Mines Date January 24, 1975

Relationship of Applicant to child

AFFIDAVIT

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

Born at Reserve in the County of Cape Breton

That Agnes RitaLeBlanc Whose Birth is sought to be registered was

born at Reserve Cape Breton County on June 1, 1920

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

The date of birth and also of baptism (6 June 1920) are both marked in the Birth and Baptismal Register of St. Joseph's Parish, Reserve for the year 1920

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