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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000726

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary AgnesBoutilier Sex Female

Date of Birth January 22, 1923 Place of Birth Little PondCounty of Cape Breton

Name of Father Bertram Boutilier MAIDEN NAME of Mother Theresa McNeil

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

Residence of Father when child was born Little Pond Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Miner Place of birth of Father Little Pond, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Agnes Currie Address of Applicant 16 Huron Avenue, Sudney Mines, Cape Breton Co., NS Date 25 April 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary AgnesBoutilier

Born at Little Pond in the County of Cape Breton

That Mary AgnesBoutilier Whose Birth is sought to be registered was

born at Little Pond Cape Breton County on January 22, 1923

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

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