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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 Elsie Laura PatriciaWagner Sex Female

Date of Birth September 12, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Herbert Wagner MAIDEN NAME of Mother Annie May Owen

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

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

Occupation of Father at Birth of child Dominion Coal Company Place of birth of Father Lunenburg

Race Name and present address of Physician in attendance at birth

Signature of Applicant Elsie Laura Patricia Wagner Address of Applicant 195 Barrington Ave., Apt. 712, Toronto, Ontario Date February 7, 1978

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Elsie Laura PatriciaWagner

Born at Glace Bay in the County of Cape Breton

That Elsie Laura PatriciaWagner Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on September 12, 1921

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

Information received from deceased parents.

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