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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000457

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Catherine ElizabethPothier Sex Female

Date of Birth October 30, 1923 Place of Birth YarmouthCounty of Yarmouth

Name of Father Bernard Pothier MAIDEN NAME of Mother Florence O'Leary

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

Residence of Father when child was born Yarmouth Ns Present address of Father Deceased

Occupation of Father at Birth of child Freight Agent - Dominion Atlantic Railway Place of birth of Father Yarmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant D. L. Chipman Address of Applicant 8 Jenkins Street, Yarmouth, NS Date 18 January 1973

Relationship of Applicant to child None

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Catherine ElizabethPothier

Born at Yarmouth in the County of Yarmouth

That Catherine ElizabethPothier Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on October 30, 1923

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

Certificate of birth & baptism from the records of St. Ambrose Cathedral, Yarmouth, NS (attached hereto)

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