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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000389

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Agnes ElizabethGouthro Sex Female

Date of Birth August 18, 1923 Place of Birth New VictoriaCounty of Cape Breton

Name of Father Frank Gouthro MAIDEN NAME of Mother Mary McPhee

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

Residence of Father when child was born New Victoria Cape Breton Co. Ns Present address of Father New Victoria, Cape Breton Co., NS

Occupation of Father at Birth of child Coal Miner Place of birth of Father Glace Bay, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Mary Gouthro Address of Applicant New Victoria, Cape Breton Co., NS Date 16 June 1970

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Agnes ElizabethGouthro

Born at New Victoria in the County of Cape Breton

That Agnes ElizabethGouthro Whose Birth is sought to be registered was

born at New Victoria Cape Breton County on August 18, 1923

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

I am the mother of said person and therefore have personal knowledge of the fact stated herein

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