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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000107

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Florence TheresaEllsworth Sex Female

Date of Birth October 11, 1923 Place of Birth ThorburnCounty of Pictou

Name of Father James Ellsworth MAIDEN NAME of Mother Mary Ann MacLean

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

Residence of Father when child was born Thorburn Pictou Co. Ns Present address of Father Thorburn, Pictou Co., NS

Occupation of Father at Birth of child Miner Place of birth of Father Thorburn, Pictou Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Florence Theresa Ellsworth Address of Applicant 52 Morris Street, Halifax, NS Date 15 June 1950

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Florence TheresaEllsworth

Born at Thorburn in the County of Pictou

That Florence TheresaEllsworth Whose Birth is sought to be registered was

born at Thorburn Pictou County on October 11, 1923

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

Evidence of baptismal certificate of St. Ann's Parish, Thorburn, Pictou Co., NS

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