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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000964

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rose EmmaTheriault Sex Female

Date of Birth August 11, 1922 Place of Birth ComeauvilleCounty of Digby

Name of Father Eddie Theriault MAIDEN NAME of Mother Marguerite Gaudet

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

Residence of Father when child was born Comeauville, Digby Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Comeauville, Digby

Race Name and present address of Physician in attendance at birth

Signature of Applicant F. Gogan Address of Applicant 5541 Stairs Place, Halifax Date 13 February 1984

Relationship of Applicant to child Brother in Law

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rose EmmaTheriault

Born at Comeauville in the County of Digby

That Rose EmmaTheriault Whose Birth is sought to be registered was

born at Comeauville Digby County on August 11, 1922

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

Baptismal

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