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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000948

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of MelvinButts Sex Male

Date of Birth May 17, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father William Butts MAIDEN NAME of Mother  Foster

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

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

Occupation of Father at Birth of child Place of birth of Father Charlottetown, Prince Edward Island

Race Name and present address of Physician in attendance at birth

Signature of Applicant Melvin Butts Address of Applicant 318 Yonge Street, Kingston, Ontario Date 11 September 1985

Relationship of Applicant to child Same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of MelvinButts

Born at Sydney in the County of Cape Breton

That MelvinButts Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 17, 1923

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

My school record (see attached)

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