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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91600779

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Edith NormaElliott Sex Female

Date of Birth October 4, 1921 Place of Birth HeathertonCounty of Antigonish

Name of Father Chester Roy Elliott MAIDEN NAME of Mother Alice Sadie Rogers

Residence of Father when child was born visiting wife's folds in Heatherton, Antigonish Co., NS Present address of Father 28 Langdon Street, Roxbury, Massachusetts, USA

Occupation of Father at Birth of child Printer (on strike) Place of birth of Father Charlestown, Massachusetts, USA

Race Name and present address of Physician in attendance at birth

Signature of Applicant Alice S. Elliott Address of Applicant 28 Langdon Street, Roxbury, Massachusetts, USA Date 10 December 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Edith NormaElliott

Born at Heatherton in the County of Antigonish

That Edith NormaElliott Whose Birth is sought to be registered was

born at Heatherton Antigonish County on October 4, 1921

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

Mother

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