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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000653

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charlotte LaviniaKaizer Sex Female

Date of Birth August 8, 1922 Place of Birth Rose BayCounty of Lunenburg

Name of Father St. Clair Kaizer MAIDEN NAME of Mother Clara Jane Wagner

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

Residence of Father when child was born Rose Bay, Lunenburg Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Rose Bay, Lunenburg

Race Name and present address of Physician in attendance at birth

Signature of Applicant Charlotte Lavinia (Kaizer) Risser Address of Applicant RR #2, Centre, Lunenburg Date 29 September 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charlotte LaviniaKaizer

Born at Rose Bay in the County of Lunenburg

That Charlotte LaviniaKaizer Whose Birth is sought to be registered was

born at Rose Bay Lunenburg County on August 8, 1922

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

I am a sister of Charlotte Lavinia Kaizer and always understood from my parents that I am two years older than my sister and that her birth date was August 8, 1922. (signed Alice Beck)

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