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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200190

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Violet BlancheBoutilier Sex Female

Date of Birth November 4, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father Gordon Bennett Boutilier MAIDEN NAME of Mother Minnie Robinson

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

Residence of Father when child was born Halifax Present address of Father 4 Fern St.

Occupation of Father at Birth of child Fisherman Place of birth of Father Indian Harbour

Race Name and present address of Physician in attendance at birth Mrs. Kelly

Signature of Applicant Gordon B. Boutilier Address of Applicant 4 Fern St. Date 14 November 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Violet BlancheBoutilier

Born at Halifax in the County of Halifax

That Violet BlancheBoutilier Whose Birth is sought to be registered was

born at Halifax Halifax County on November 4, 1919

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

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