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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200484

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Harold AlbertBoutilier Sex Male

Date of Birth December 27, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father John Henry Boutilier MAIDEN NAME of Mother Josephine Mary Boutilier

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

Residence of Father when child was born Halifax Present address of Father 53 LeMarchant St.

Occupation of Father at Birth of child Chauffeur Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth Dr. Corston

Signature of Applicant John Henry Boutilier Address of Applicant 53 LeMarchant St. Date 14 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Harold AlbertBoutilier

Born at Halifax in the County of Halifax

That Harold AlbertBoutilier Whose Birth is sought to be registered was

born at Halifax Halifax County on December 27, 1919

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

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