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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

36900430

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Gerald BarthelmySurette Sex Male

Date of Birth August 24, 1924 Place of Birth Eel BrookCounty of Yarmouth

Name of Father William Surette MAIDEN NAME of Mother Vitaline Leblanc

Residence of Father when child was born Eel Brook, Yarmouth Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Eel Brook, Yarmouth Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Vitaline Surette Address of Applicant South Belleville, Yarmouth Co., NS Date 3 November 1930

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Gerald BarthelmySurette

Born at Eel Brook in the County of Yarmouth

That Gerald BarthelmySurette Whose Birth is sought to be registered was

born at Eel Brook Yarmouth County on August 24, 1924

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

Extract from church records attached

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