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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000026

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of AliceLebouis Sex Female

Date of Birth February 13, 1920 Place of Birth Reserve MinesCounty of Cape Breton

Name of Father   MAIDEN NAME of Mother Alice Lebouis

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth Dr. Gannon, Reserve Mines

Signature of Applicant Mde. Marcelle Lebouis Vignis Address of Applicant 146 Visitation St. Montreal, Quebec Date November 3, 1946

Relationship of Applicant to child Aunt

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of AliceLebouis

Born at Reserve Mines in the County of Cape Breton

That AliceLebouis Whose Birth is sought to be registered was

born at Reserve Mines Cape Breton County on February 13, 1920

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

Assisted at time of Birth

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