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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000602

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Evangeline Agnes EmmaBellefontaine Sex Female

Date of Birth February 27, 1924 Place of Birth LanarkCounty of Antigonish

Name of Father Stephen Bellefontaine MAIDEN NAME of Mother Isabelle Gallant

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

Residence of Father when child was born Lanark, Antigonish Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Halifax, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Evangeline Crossman Address of Applicant Post Road, Antigonish Co., NS Date 19 January 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Evangeline Agnes EmmaBellefontaine

Born at Lanark in the County of Antigonish

That Evangeline Agnes EmmaBellefontaine Whose Birth is sought to be registered was

born at Lanark Antigonish County on February 27, 1924

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

Knowledge from my parents and church records

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