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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000086

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary MadonnaEllsworth Sex Female

Date of Birth August 25, 1922 Place of Birth DominionCounty of Cape Breton

Name of Father Michael Ellsworth MAIDEN NAME of Mother Catherine Campbell

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

Residence of Father when child was born Dominion, Cape Breton Present address of Father 21 Union Street, Dominion, Cape Breton

Occupation of Father at Birth of child Coal Miner Place of birth of Father Low Point, Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary M. Ellsworth Address of Applicant 321 Bloor Street West, Toronto, Ontario Date 5 April 1949

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary MadonnaEllsworth

Born at Dominion in the County of Cape Breton

That Mary MadonnaEllsworth Whose Birth is sought to be registered was

born at Dominion Cape Breton County on August 25, 1922

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

That my mother and father have frequently told me that I was born on August 25th, 1922 and that date has always been celebrated by my family and myself as my birth date. That I have in my possession my baptismal certificate issued by Father Charles MacDonald, showing August 25th, 1922 to be my birth date.

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