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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000281

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles FrancisBoutilier Sex

Date of Birth March 27, 1920 Place of Birth StellartonCounty of Pictou

Name of Father Henry William Boutilier MAIDEN NAME of Mother Ellen Cecelia Foley

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

Residence of Father when child was born Stellarton Present address of Father New Glasgow

Occupation of Father at Birth of child Crane Operator (Printer) Place of birth of Father Stellarton

Race White Name and present address of Physician in attendance at birth Dr. G.W. Whitman, Stellarton (Deceased)

Signature of Applicant C. F. Boutilier Address of Applicant Middleton Date August 30, 1957

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles FrancisBoutilier

Born at Stellarton in the County of Pictou

That Charles FrancisBoutilier Whose Birth is sought to be registered was

born at Stellarton Pictou County on March 27, 1920

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

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