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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000495

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charles WilliamThibodeau Sex Male

Date of Birth October 28, 1924 Place of Birth BrooklynCounty of

Name of Father Charles E. Thibodeau MAIDEN NAME of Mother Annie Rogers

Residence of Father when child was born Brooklyn, Yarmouth Co., NS Present address of Father Brooklyn, Yarmouth Co., NS

Occupation of Father at Birth of child Retired Lumberman Place of birth of Father Brooklyn, Yarmouth Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Annie Rogers Thibodeau Address of Applicant Brooklyn, Yarmouth Co., NS Date 28 October 1924

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charles WilliamThibodeau

Born at Brooklyn in the County of

That Charles WilliamThibodeau Whose Birth is sought to be registered was

born at Brooklyn County on October 28, 1924

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

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