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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93300556

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Archange EmerySurette Sex Male

Date of Birth March 26, 1906 Place of Birth Middle West PubnicoCounty of Yarmouth

Name of Father Charles F. Surette MAIDEN NAME of Mother Ursule Deon

Residence of Father when child was born Middle West Pubnico Present address of Father West Pubnico

Occupation of Father at Birth of child Butcher Place of birth of Father Middle West Pubnico

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

Signature of Applicant Archange Emery Surette Address of Applicant Middle West Pubnico Date 3 October 1925

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Archange EmerySurette

Born at Middle West Pubnico in the County of Yarmouth

That Archange EmerySurette Whose Birth is sought to be registered was

born at Middle West Pubnico Yarmouth County on March 26, 1906

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

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