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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000893

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marie E. Boudreau Sex Female

Date of Birth December 1, 1920 Place of Birth Petit de GratCounty of Richmond

Name of Father Denis Boudreau MAIDEN NAME of Mother Elizabeth Rose Samson

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

Residence of Father when child was born Petit de Grat Present address of Father deceased

Occupation of Father at Birth of child Fisherman Place of birth of Father Petit de Grat

Race Name and present address of Physician in attendance at birth

Signature of Applicant Clifford Boudreau Address of Applicant Petit de Grat Date February 15, 1978

Relationship of Applicant to child brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marie E. Boudreau

Born at Petit de Grat in the County of Richmond

That Marie E. Boudreau Whose Birth is sought to be registered was

born at Petit de Grat Richmond County on December 1, 1920

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

Baptism and Birth Certificate from St. Joseph Parish, Petit de Grat. Also information received from parents.

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