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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000731

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lewis AlfredBourque Sex Male

Date of Birth March 29, 1924 Place of Birth YarmouthCounty of Yarmouth

Name of Father Augustin Bourque MAIDEN NAME of Mother Rose Aime Doucette

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

Residence of Father when child was born Yarmouth, NS Present address of Father Deceased

Occupation of Father at Birth of child Place of birth of Father Yarmouth, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Lewis Alfred Bourque Address of Applicant RR #13, Thunder Bay, Ontario Date March 1982

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lewis AlfredBourque

Born at Yarmouth in the County of Yarmouth

That Lewis AlfredBourque Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on March 29, 1924

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

Baptism certificate, church records previously submitted

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