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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000303

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Irene DorothyBoutilier Sex Female

Date of Birth July 25, 1924 Place of Birth HalifaxCounty of Halifax

Name of Father Clyde O. Boutilier MAIDEN NAME of Mother Hattie A. Hubley

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

Residence of Father when child was born Seabright, Halifax Co., NS Present address of Father Seabright, Halifax Co., NS

Occupation of Father at Birth of child Ship Steward Place of birth of Father Seabright, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Clyde O. Boutilier Address of Applicant Seabright, Halifax Co., NS Date 16 August 1967

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Irene DorothyBoutilier

Born at Halifax in the County of Halifax

That Irene DorothyBoutilier Whose Birth is sought to be registered was

born at Halifax Halifax County on July 25, 1924

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

The date of birth is known to me as her father and I were working together in the hay field on the day she was born. In addition, I resided next door to her parents

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