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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000309

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Octavie JulietteBourque Sex Female

Date of Birth February 5, 1921 Place of Birth Eel BrookCounty of Yarmouth

Name of Father Leander Bourque MAIDEN NAME of Mother Adele Bourque

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

Residence of Father when child was born Eel Brook Present address of Father deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Eel Brook

Race French Name and present address of Physician in attendance at birth Dr. A. Melanson

Signature of Applicant Octavie Juliette Bourque Address of Applicant Abrams River Date January 15, 1962

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Octavie JulietteBourque

Born at Eel Brook in the County of Yarmouth

That Octavie JulietteBourque Whose Birth is sought to be registered was

born at Eel Brook Yarmouth County on February 5, 1921

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

Certificate of Baptism from the Eel Brook Parish Records

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