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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100182

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Josue Vincent JosephSurette Sex Male

Date of Birth November 15, 1921 Place of Birth Pinkneys PointCounty of Yarmouth

Name of Father Charles Surette MAIDEN NAME of Mother Eva Melanson

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

Residence of Father when child was born Pinkneys Point Present address of Father deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Pinkneys Point

Race Name and present address of Physician in attendance at birth

Signature of Applicant Frances Mae Surette Address of Applicant Arcadia RR1 Box 1450 Yarmouth County Date August 7, 1986

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Josue Vincent JosephSurette

Born at Pinkneys Point in the County of Yarmouth

That Josue Vincent JosephSurette Whose Birth is sought to be registered was

born at Pinkneys Point Yarmouth County on November 15, 1921

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

I have in my possession (copy enclosed) Baptismal Certificate indicating that Josue Vincent Joseph Surette was born in Pinkneys Point Yarmouth on Nov 15, 1921, and Baptised in Westport on Nov 20, 1921

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