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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000152

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marie EstelleBoucher Sex Female

Date of Birth December 17, 1921 Place of Birth ArichatCounty of Richmond

Name of Father Albert Simon Boucher MAIDEN NAME of Mother Marie E. Boudreau

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

Residence of Father when child was born Arichat Present address of Father deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Arichat

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

Signature of Applicant Marie E. Boucher Address of Applicant Arichat Date

Relationship of Applicant to child Daughter

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marie EstelleBoucher

Born at Arichat in the County of Richmond

That Marie EstelleBoucher Whose Birth is sought to be registered was

born at Arichat Richmond County on December 17, 1921

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

By Baptismal Certificate

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