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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000730

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ella MayGoss Sex

Date of Birth May 16, 1920 Place of Birth StellartonCounty of Pictou

Name of Father Joseph Goss MAIDEN NAME of Mother Annabel Bourgeois

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

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

Occupation of Father at Birth of child Miner Place of birth of Father Essex, England

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ella M. Smith Address of Applicant 51 Pine, New Glasgow Date April 11, 1975

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ella MayGoss

Born at Stellarton in the County of Pictou

That Ella MayGoss Whose Birth is sought to be registered was

born at Stellarton Pictou County on May 16, 1920

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

Certificate of Birth and Baptism attached and fact that my mother gave me particulars of date of birth. Marriage extract #42-2-117343.

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