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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000592

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Wilfred AmbroseDeCoste Sex Male

Date of Birth October 12, 1923 Place of Birth Havre BoucherCounty of Antigonish

Name of Father William Decoste MAIDEN NAME of Mother Florence Petipas

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

Residence of Father when child was born Havre Boucher Antigonish Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Havre Boucher, Antigonish Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ambrose W. Decoste Address of Applicant 29 Cloverhill Avenue Date 12 January 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Wilfred AmbroseDeCoste

Born at Havre Boucher in the County of Antigonish

That Wilfred AmbroseDeCoste Whose Birth is sought to be registered was

born at Havre Boucher Antigonish County on October 12, 1923

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

Information provided by Wilfred Ambrose DeCoste as shown on baptismal certificate.

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