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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000970

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Wallace ElsworthBorgal Sex Male

Date of Birth September 17, 1922 Place of Birth Pleasant HarbourCounty of Halifax

Name of Father Harry D. Borgal MAIDEN NAME of Mother Alma Viola Clattenburg

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

Residence of Father when child was born Pleasant Harbour, Halifax Present address of Father Deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Pleasant Harbour, Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Vern Fraser Address of Applicant RR #1, Tangier, Halifax Date 23 March 1984

Relationship of Applicant to child Friend

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Wallace ElsworthBorgal

Born at Pleasant Harbour in the County of Halifax

That Wallace ElsworthBorgal Whose Birth is sought to be registered was

born at Pleasant Harbour Halifax County on September 17, 1922

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

Baptismal

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