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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000856

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Emma JeanetteWilson Sex Female

Date of Birth October 23, 1921 Place of Birth Malagash MineCounty of Cumberland

Name of Father Herbert Wilson MAIDEN NAME of Mother Elida C. Miller

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

Residence of Father when child was born Malagash Mine Present address of Father Malagash Mine

Occupation of Father at Birth of child Miner Place of birth of Father Westville

Race Name and present address of Physician in attendance at birth

Signature of Applicant Emma Jeanette Broughton Address of Applicant Westchester Date October 9, 1979

Relationship of Applicant to child Mother and Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Emma JeanetteWilson

Born at Malagash Mine in the County of Cumberland

That Emma JeanetteWilson Whose Birth is sought to be registered was

born at Malagash Mine Cumberland County on October 23, 1921

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

Always celebrated Birthdate on this date

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