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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000308

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Samuel RoyButler Sex Male

Date of Birth January 21, 1923 Place of Birth Glace BayCounty of Cape Breton

Name of Father Samuel Butler MAIDEN NAME of Mother Ella Edwards

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

Residence of Father when child was born Glace Bay Cape Breton Co. Ns Present address of Father 8 Flemington Road, Toronto, Ontario

Occupation of Father at Birth of child Miner Place of birth of Father Newfoundland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ella Butler Address of Applicant 8 Flemington Road, Toronto, Ontario Date 8 July 1965

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Samuel RoyButler

Born at Glace Bay in the County of Cape Breton

That Samuel RoyButler Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on January 21, 1923

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

Mother

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