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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

65400262

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 15, 1924 Place of Birth Sydney MinesCounty of Cape Breton

Name of Father John W. Chase MAIDEN NAME of Mother Effie McKinnon

Residence of Father when child was born Sydney Mines, Cape Breton Co., NS Present address of Father Sydney Mines, Cape Breton Co., NS

Occupation of Father at Birth of child Coal Miner Place of birth of Father Neils Harbour, Victoria Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant John W. Chase Address of Applicant Sydney Mines, Cape Breton Co., NS Date 13 January 1927

Relationship of Applicant to child Father

AFFIDAVIT

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

Born at Sydney Mines in the County of Cape Breton

That Annie EthelChase Whose Birth is sought to be registered was

born at Sydney Mines Cape Breton County on January 15, 1924

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

Copy of Baptismal record

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