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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000995

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles SylvesterBoucher Sex Male

Date of Birth June 28, 1921 Place of Birth East Havre BoucherCounty of Antigonish

Name of Father Arthur Boucher MAIDEN NAME of Mother Catherine Forgere

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

Residence of Father when child was born East Havre Boucher Present address of Father deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father East Havre Boucher

Race Name and present address of Physician in attendance at birth

Signature of Applicant Charles S. Boucher Address of Applicant Havre Boucher Date November 1982

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles SylvesterBoucher

Born at East Havre Boucher in the County of Antigonish

That Charles SylvesterBoucher Whose Birth is sought to be registered was

born at East Havre Boucher Antigonish County on June 28, 1921

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

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