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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200045

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John CharlesTheriault Sex Male

Date of Birth October 9, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Frank Theriault MAIDEN NAME of Mother Mary Theriault

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

Residence of Father when child was born Halifax Present address of Father 18 Bishop St.

Occupation of Father at Birth of child Seaman Place of birth of Father House Harbour, Magdalen Islands

Race Name and present address of Physician in attendance at birth Miller

Signature of Applicant Frank Theriault Address of Applicant 18 Bishop St. Date 21 October 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John CharlesTheriault

Born at Halifax in the County of Halifax

That John CharlesTheriault Whose Birth is sought to be registered was

born at Halifax Halifax County on October 9, 1919

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

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