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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000386

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 31, 1924 Place of Birth New WaterfordCounty of Cape Breton

Name of Father Louis VanDornick MAIDEN NAME of Mother Antonia Horwath

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

Residence of Father when child was born New Waterford, Cape Breton Co., NS Present address of Father Amelia Street, Scotchtown, New Waterford, Cape Breton Co., NS

Occupation of Father at Birth of child Miner Place of birth of Father Belgium

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Mary Keusch Address of Applicant 721 Mahon Street, New Waterford, Cape Breton Co., NS Date 1 March 1973

Relationship of Applicant to child Aunt

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Annie Louise MargaretVanDornick

Born at New Waterford in the County of Cape Breton

That Annie Louise MargaretVanDornick Whose Birth is sought to be registered was

born at New Waterford Cape Breton County on December 31, 1924

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

I am her Aunt and I distinctly remember the date of her birth. I was present in my mother's home when she was born

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