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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000872

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Michael FabianBoutilieer Sex Male

Date of Birth January 20, 1923 Place of Birth Glace BayCounty of Cape Breton

Name of Father William Henry Boutilier MAIDEN NAME of Mother Mary Ann Campbell

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

Residence of Father when child was born New Aberdeen Glace Bay Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Engineer - Coal Company Place of birth of Father Reserve Mines, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Michael Fabian Boutilier Address of Applicant RR #1, Port Caledonia, Cape Breton Co., NS Date 15 March 1983

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Michael FabianBoutilieer

Born at Glace Bay in the County of Cape Breton

That Michael FabianBoutilieer Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on January 20, 1923

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

Taken from the Baptismal records of St. John the Baptist Church, 171 Eleventh Street, Glace Bay, NS

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