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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100027

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Henry MatthiasGouthro Sex Male

Date of Birth June 21, 1921 Place of Birth Reserve MinesCounty of Cape Breton

Name of Father Simon Francis Gouthro MAIDEN NAME of Mother Christina MacNeil

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

Residence of Father when child was born Reserve Mines Present address of Father deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Frenchvale

Race Name and present address of Physician in attendance at birth

Signature of Applicant Henry Mattias Gouthro Address of Applicant 140 Dixon Rd. Weston, Ontario Date April 14, 1983

Relationship of Applicant to child Applicant is applying

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Henry MatthiasGouthro

Born at Reserve Mines in the County of Cape Breton

That Henry MatthiasGouthro Whose Birth is sought to be registered was

born at Reserve Mines Cape Breton County on June 21, 1921

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

1. I am the Applicant 2. enclosed herewith please find certified and notarial copy of Baptismal Certificate and we enclose herewith Notarial copy of Canadian Army Discharge Certificate. 3. I am also known as Harry Gouthro

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