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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000722

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Anne AgnesSurette Sex Female

Date of Birth December 2, 1921 Place of Birth Lower Eel BrookCounty of Yarmouth

Name of Father Xyste Surette MAIDEN NAME of Mother Rosalie Pottier

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 Fisherman Place of birth of Father Nova Scotia

Race Name and present address of Physician in attendance at birth

Signature of Applicant R. MacDougall Address of Applicant 3230 Albion Rd. Ottawa, Ontario Date January 9, 1978

Relationship of Applicant to child Son-in-law

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Anne AgnesSurette

Born at Lower Eel Brook in the County of Yarmouth

That Anne AgnesSurette Whose Birth is sought to be registered was

born at Lower Eel Brook Yarmouth County on December 2, 1921

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

Baptismal Marriage Extract

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