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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000370

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Peter SimonFougere Sex Male

Date of Birth January 31, 1921 Place of Birth South BarCounty of Cape Breton

Name of Father Simon Fougere MAIDEN NAME of Mother Victoria Gracie

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

Residence of Father when child was born South Bar Present address of Father South Bar

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

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

Signature of Applicant Alice Gale Address of Applicant South Bar Date February 27, 1967

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Peter SimonFougere

Born at South Bar in the County of Cape Breton

That Peter SimonFougere Whose Birth is sought to be registered was

born at South Bar Cape Breton County on January 31, 1921

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

My father has informed me that my brother Peter Simon Fougere was born on January 31, 1921 at South Bar, in the County of Cape Breton.

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