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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000310

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ethel JeanPayne Sex Female

Date of Birth January 21, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father Samuel Payne MAIDEN NAME of Mother Hannah Moore

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

Residence of Father when child was born Glace Bay, Cape Breton Present address of Father V=Glace Bay, Cape Breton

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ethel Westbury Address of Applicant Sutton West, Ontario Date 26 August 1963

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ethel JeanPayne

Born at Glace Bay in the County of Cape Breton

That Ethel JeanPayne Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on January 21, 1922

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

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