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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000392

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gene BurtonTibert Sex Male

Date of Birth April 6, 1920 Place of Birth FreeportCounty of Digby

Name of Father Robie Burton  Tibert MAIDEN NAME of Mother Annie Mae Thurber

Residence of Father when child was born Freeport Present address of Father Freeport

Occupation of Father at Birth of child Fisherman Place of birth of Father Central Grove

Race English Name and present address of Physician in attendance at birth Dr. A.F. Weir

Signature of Applicant Annie Mae Tibert Address of Applicant Freeport Date November 14, 1941

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gene BurtonTibert

Born at Freeport in the County of Digby

That Gene BurtonTibert Whose Birth is sought to be registered was

born at Freeport Digby County on April 6, 1920

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

I am his mother

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