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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91800026

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Katherine IsobelSurette Sex Female

Date of Birth January 3, 1923 Place of Birth ArcadiaCounty of Yarmouth

Name of Father Leon Surette MAIDEN NAME of Mother Gertrude Mary Berry

Residence of Father when child was born Arcadia, Yarmouth Co., NS Present address of Father Yarmouth, NS

Occupation of Father at Birth of child Labourer Place of birth of Father Salmon River, Digby Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Gertrude Mary Surette Address of Applicant Yarmouth, NS Date 12 April 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Katherine IsobelSurette

Born at Arcadia in the County of Yarmouth

That Katherine IsobelSurette Whose Birth is sought to be registered was

born at Arcadia Yarmouth County on January 3, 1923

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

I am the mother of Katherine Isobel Surette

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