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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000197

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marie Alice CorinneBourque Sex Female

Date of Birth October 4, 1922 Place of Birth AmherstCounty of Cumberland

Name of Father Belonie Joseph Bourque MAIDEN NAME of Mother Virginia Ann LeBlanc

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

Residence of Father when child was born 7 Park Street, Amherst, Cumberland Present address of Father 7 Park Street, Amherst, Cumberland

Occupation of Father at Birth of child Steel Worker at Canadian Car & Foundry Place of birth of Father Shediac, New Brunswick

Race Name and present address of Physician in attendance at birth

Signature of Applicant C. A. Burke Address of Applicant 172 Queen Street, Moncton, New Brunswick Date 11 October 1955

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marie Alice CorinneBourque

Born at Amherst in the County of Cumberland

That Marie Alice CorinneBourque Whose Birth is sought to be registered was

born at Amherst Cumberland County on October 4, 1922

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

I am her father and saw her shortly after birth. Certificate of baptism

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