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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700520

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ella EvelynPayne Sex Female

Date of Birth October 20, 1919 Place of Birth Glace BayCounty of Cape Breton

Name of Father Samuel Payne MAIDEN NAME of Mother Hannah Moore

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

Residence of Father when child was born Glace Bay Present address of Father

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

Race Name and present address of Physician in attendance at birth Dr. Calder

Signature of Applicant Hannah Payne Address of Applicant Glace Bay Date 25 October 1919

Relationship of Applicant to child mother

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That Ella EvelynPayne Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on October 20, 1919

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

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