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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000612

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 19, 1921 Place of Birth Tufts CoveCounty of Halifax

Name of Father Walter Gordon Wournell MAIDEN NAME of Mother Clara M. Tufts

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

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

Occupation of Father at Birth of child C.N. Brakeman Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Alica Ardge Address of Applicant 37 Johnston Ave. Dartmouth Apt. 6 Date February 9, 1976

Relationship of Applicant to child daughter

AFFIDAVIT

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

Born at Tufts Cove in the County of Halifax

That Madeline ClaraWournell Whose Birth is sought to be registered was

born at Tufts Cove Halifax County on June 19, 1921

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

Baptism

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