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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000179

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Joseph RaymondEllsworth Sex Male

Date of Birth March 19, 1924 Place of Birth DominionCounty of Cape Breton

Name of Father Michael Ellsworth MAIDEN NAME of Mother Catherine Campbell

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

Residence of Father when child was born 21 Union Street, Dominion, Cape Breton Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Miner Place of birth of Father Low Point, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary M. Ellsworth Address of Applicant 21 Union Street, Dominion, Cape Breton Co., NS Date 22 September 1956

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Joseph RaymondEllsworth

Born at Dominion in the County of Cape Breton

That Joseph RaymondEllsworth Whose Birth is sought to be registered was

born at Dominion Cape Breton County on March 19, 1924

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

Birth certificate copied from Parish records

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