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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900541

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Anna LouiseBerggren Sex Female

Date of Birth May 11, 1921 Place of Birth Upper SackvilleCounty of Halifax

Name of Father Chester Homer Berggren MAIDEN NAME of Mother Violet Ethel Withrow

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

Residence of Father when child was born Upper Sackville, Halifax, NS Present address of Father Upper Sackville, Halifax, NS

Occupation of Father at Birth of child Farmer Place of birth of Father South Rawdon, Hants Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Violet Berggren Address of Applicant Upper Sackville, Halifax, NS Date 14 June 1945

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Anna LouiseBerggren

Born at Upper Sackville in the County of Halifax

That Anna LouiseBerggren Whose Birth is sought to be registered was

born at Upper Sackville Halifax County on May 11, 1921

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

I am the mother of Anna Louise Berggren

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