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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000322

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy MaryBoutilier Sex Female

Date of Birth December 15, 1924 Place of Birth Glace BayCounty of Cape Breton

Name of Father   MAIDEN NAME of Mother Catherine Elizabeth Boutilier

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dorothy M. Quackenbush Address of Applicant 23 McGilvray Crescent, Georgetown, Ontario Date 21 July 1969

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy MaryBoutilier

Born at Glace Bay in the County of Cape Breton

That Dorothy MaryBoutilier Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 15, 1924

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

Baptismal certificate

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