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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000217

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy RetaBoucher Sex Female

Date of Birth March 11, 1921 Place of Birth AmherstCounty of Cumberland

Name of Father Joseph Richard Boucher MAIDEN NAME of Mother Reta Bridgitta O'Brien

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

Residence of Father when child was born Amherst Present address of Father not known USA

Occupation of Father at Birth of child CNR Place of birth of Father Moncton, New Brunswick

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

Signature of Applicant Reta B. Coates Address of Applicant 12 Alder Cres. Deep River, Ontario Date November 5, 1955

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy RetaBoucher

Born at Amherst in the County of Cumberland

That Dorothy RetaBoucher Whose Birth is sought to be registered was

born at Amherst Cumberland County on March 11, 1921

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

I am her Mother School Records and Baptism Certificate attached

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