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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000420

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 19, 1924 Place of Birth Glace BayCounty of Cape Breton

Name of Father Talbot Norris Butts MAIDEN NAME of Mother Florence Mary LeRoux

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

Residence of Father when child was born Glace Bay, Cape Breton Co., NS Present address of Father Jeffrey's, Newfoundland

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Daniel Butts Address of Applicant Sydney Road, Reserve Mines, Cape Breton Co., NS Date 6 March 1974

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That DanielButts Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on September 19, 1924

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

I have always celebrated my birthday on that date. My parents always told me I was born on September 19, 1924 and I enlose baptismal certificate and copy of record of superintendent of Schools where both indicate that I was born September 19, 1924

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