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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000673

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lottie AlexandraGillis Sex Female

Date of Birth August 12, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Laughlin Dan Gillis MAIDEN NAME of Mother Mary Catherine Ferguson

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

Residence of Father when child was born Sydney Present address of Father 215 Royal Ave.

Occupation of Father at Birth of child Carpenter Place of birth of Father Orangeville

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. B. Ward Address of Applicant 218-F Duncanwood Dr. Toronto, Ontario Date August 10, 1976

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lottie AlexandraGillis

Born at Sydney in the County of Cape Breton

That Lottie AlexandraGillis Whose Birth is sought to be registered was

born at Sydney Cape Breton County on August 12, 1921

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

Class A Certificate of Baptism, now in the possession of the Registrar General of Nova Scotia, together with my personal knowledge. That Charlotte Ward is the married name of the said Lottie Alexandra Gillis.

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