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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500002

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Emma MaryBourque Sex Female

Date of Birth October 2, 1919 Place of Birth AmherstCounty of Cumberland

Name of Father Joseph Anthony Bourque MAIDEN NAME of Mother Mary Tibideau

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

Residence of Father when child was born Amherst Present address of Father 30 Prince Arthur St.

Occupation of Father at Birth of child Shoe maker Place of birth of Father Shediac, NB

Race Name and present address of Physician in attendance at birth Dr. F.E. Boudreau

Signature of Applicant Joseph Anthony Bourque Address of Applicant 30 Prince Arthur St. Date 16 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Emma MaryBourque

Born at Amherst in the County of Cumberland

That Emma MaryBourque Whose Birth is sought to be registered was

born at Amherst Cumberland County on October 2, 1919

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

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