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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000641

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Frederick JeromeGouthro Sex Male

Date of Birth October 17, 1923 Place of Birth North SydneyCounty of Cape Breton

Name of Father Charles Andrew Gouthro MAIDEN NAME of Mother Elizabeth White

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

Residence of Father when child was born Emerald Street North Sydney Cape Breton Co. Ns Present address of Father Northside Guest Home

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Fred J. Gouthro Address of Applicant 137 West Street, North Sydney, Cape Breton Co., NS Date 24 April 1978

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Frederick JeromeGouthro

Born at North Sydney in the County of Cape Breton

That Frederick JeromeGouthro Whose Birth is sought to be registered was

born at North Sydney Cape Breton County on October 17, 1923

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

Certificate of birth & baptism - St. Joseph's Church, North Sydney, given July 7, 1959

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