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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700552

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Annie MaudEllis Sex Female

Date of Birth February 1, 1922 Place of Birth HalifaxCounty of Halifax

Name of Father Edmund Ellis MAIDEN NAME of Mother Anna Crocker

Residence of Father when child was born 17 Cabot Place, Halifax, NS Present address of Father Deceased

Occupation of Father at Birth of child Carpenter with Imperial Oil Place of birth of Father Hearts Delight, Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Anna Ellis Address of Applicant 68 A Hawthorne Street, Dartmouth, NS Date 22 June 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Annie MaudEllis

Born at Halifax in the County of Halifax

That Annie MaudEllis Whose Birth is sought to be registered was

born at Halifax Halifax County on February 1, 1922

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

I am her mother and well remember said date.

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