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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000449

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of ElizabethGouthro Sex Female

Date of Birth May 2, 1921 Place of Birth Gardiner MinesCounty of Cape Breton

Name of Father Joseph Gouthro MAIDEN NAME of Mother Ellen Boutilier

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

Residence of Father when child was born Gardiner Mines Present address of Father Gardiner Mines

Occupation of Father at Birth of child Miner Place of birth of Father Gardiner Mines

Race English Name and present address of Physician in attendance at birth M.G. Tompkins

Signature of Applicant Elizabeth Boutilier Address of Applicant Dominion Date December 12, 1970

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of ElizabethGouthro

Born at Gardiner Mines in the County of Cape Breton

That ElizabethGouthro Whose Birth is sought to be registered was

born at Gardiner Mines Cape Breton County on May 2, 1921

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

Certification from records of Immaculate Conception Church, Bridgeport

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