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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000610

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ann IreneCouture Sex Female

Date of Birth July 1, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Clifford Couture MAIDEN NAME of Mother Margaret Morley

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

Residence of Father when child was born Davenport Rd. Sydney Present address of Father deceased

Occupation of Father at Birth of child Steelworker Place of birth of Father New Brunswick

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Margaret Couture Address of Applicant 79 Rigby Rd. Sydney Date December 22, 1975

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ann IreneCouture

Born at Sydney in the County of Cape Breton

That Ann IreneCouture Whose Birth is sought to be registered was

born at Sydney Cape Breton County on July 1, 1921

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

I am the mother of Ann Irene Couture and well recall the date of her birth

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