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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100204

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of HectorBoutilier Sex Male

Date of Birth April 14, 1920 Place of Birth Little PondCounty of Cape Breton

Name of Father Bert Boutilier MAIDEN NAME of Mother Teresa MacNeil

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

Residence of Father when child was born Little Pond Present address of Father deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Little Pond

Race Name and present address of Physician in attendance at birth

Signature of Applicant C.W. Couture Address of Applicant Halifax Date March 29, 1983

Relationship of Applicant to child son-in-law

AFFIDAVIT

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

Born at Little Pond in the County of Cape Breton

That HectorBoutilier Whose Birth is sought to be registered was

born at Little Pond Cape Breton County on April 14, 1920

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

Baptismal

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