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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000879

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Harley GeorgeAmirault Sex Male

Date of Birth March 14, 1920 Place of Birth Plympton StationCounty of Digby

Name of Father Hedert Amirault MAIDEN NAME of Mother Gertrude D'Ambroise

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

Residence of Father when child was born Plympton Station Present address of Father deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Harley G. Amirault Address of Applicant Plympton Date December 2, 1977

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Harley GeorgeAmirault

Born at Plympton Station in the County of Digby

That Harley GeorgeAmirault Whose Birth is sought to be registered was

born at Plympton Station Digby County on March 14, 1920

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

Baptismal Certificate

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