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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100061

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clifford FrancisLeBoutillier Sex Male

Date of Birth June 28, 1923 Place of Birth CheticampCounty of Inverness

Name of Father Herbert John Leboutillier MAIDEN NAME of Mother Ruby May Lebrun

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

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father St. Mary Parish, Jersey, Channel Islands

Race Name and present address of Physician in attendance at birth

Signature of Applicant Herbert S. Leboutillier Address of Applicant Cheticamp Date November 15, 1991

Relationship of Applicant to child Brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clifford FrancisLeBoutillier

Born at Cheticamp in the County of Inverness

That Clifford FrancisLeBoutillier Whose Birth is sought to be registered was

born at Cheticamp Inverness County on June 28, 1923

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

Clifford LeBoutillier is my brother three years younger than I am. We grew up in the same family and went to school together. School Census 1937 and national census records of June 1st 1931 and 1941 support birthdate of 28 June 1923 (Record based on School for Census 1941 For Given Names and Parents names National Registration for Place of Birth only Bap).

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