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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000877

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rita BerylThomas Sex Female

Date of Birth September 9, 1923 Place of Birth HalifaxCounty of Halifax

Name of Father Albert Victor MAIDEN NAME of Mother Katherine Burke

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

Residence of Father when child was born Halifax Ns Present address of Father Deceased

Occupation of Father at Birth of child Postman Place of birth of Father Halifax, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Rita Boutilier Address of Applicant Tantallon, Halifax Co., NS Date 8 September 1983

Relationship of Applicant to child Myself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rita BerylThomas

Born at Halifax in the County of Halifax

That Rita BerylThomas Whose Birth is sought to be registered was

born at Halifax Halifax County on September 9, 1923

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

My baptism paper from St. Patricks church records.

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