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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000371

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Madeline RoseFralick Sex Female

Date of Birth October 28, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father Linwood Fralick MAIDEN NAME of Mother Florence Payzant

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

Residence of Father when child was born Halifax Present address of Father 17 Chestnut Dr. Dartmouth

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

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

Signature of Applicant Earl J. Fralick Address of Applicant 355 Goulburn Cres. Apt 1, Ottawa, Ontario Date 1 February 1967

Relationship of Applicant to child Brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Madeline RoseFralick

Born at Halifax in the County of Halifax

That Madeline RoseFralick Whose Birth is sought to be registered was

born at Halifax Halifax County on October 28, 1921

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

School Record Baptismal

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