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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000005

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy EvangelineWagner Sex Female

Date of Birth October 1, 1922 Place of Birth BridgetownCounty of Annapolis

Name of Father Clifford Roy Wagner MAIDEN NAME of Mother Sarah Agnes Burns

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

Residence of Father when child was born Bridgetown, Annapolis Present address of Father

Occupation of Father at Birth of child Labourer Place of birth of Father Annapolis Royal, Annapolis

Race Name and present address of Physician in attendance at birth

Signature of Applicant Clifford Roy Wagner Address of Applicant Berwick, Kings Date 13 March 1947

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy EvangelineWagner

Born at Bridgetown in the County of Annapolis

That Dorothy EvangelineWagner Whose Birth is sought to be registered was

born at Bridgetown Annapolis County on October 1, 1922

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

I am the father of the said Dorothy Evangeline Wagner who was born in my home at Bridgetown, aforesaid when I was personally present in the home and I remember the date of her birth

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