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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000558

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Douglas CharlesSurrette Sex Male

Date of Birth February 14, 1923 Place of Birth YarmouthCounty of Yarmouth

Name of Father Fred Alfred Surrette MAIDEN NAME of Mother Rosie Belfie Chemist

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 Fisherman Place of birth of Father Yarmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Charles Douglas Surrette Address of Applicant 13 Albert Street, Yarmouth, NS Date 13 January 1975

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Douglas CharlesSurrette

Born at Yarmouth in the County of Yarmouth

That Douglas CharlesSurrette Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on February 14, 1923

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

He was living at 100 Main Street. He is 6 years younger than I am. He and my brother Stanley Bishara were born within one year of Stan's birthday.

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