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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100231

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Helen MargaretFougere Sex Female

Date of Birth November 9, 1921 Place of Birth PoulamonCounty of Richmond

Name of Father Ernest Simon Fougere MAIDEN NAME of Mother Mary Elizabeth Burke

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

Residence of Father when child was born Poulamon Present address of Father

Occupation of Father at Birth of child Place of birth of Father Poulamon

Race Name and present address of Physician in attendance at birth

Signature of Applicant Helen Margaret Goyeche Address of Applicant 22 Slayter St. Dartmouth Date May 18, 1999

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Helen MargaretFougere

Born at Poulamon in the County of Richmond

That Helen MargaretFougere Whose Birth is sought to be registered was

born at Poulamon Richmond County on November 9, 1921

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

Baptismal and Marriage Record

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