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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000950

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jean AlfredSurette Sex Male

Date of Birth December 29, 1924 Place of Birth Sluice PointCounty of Yarmouth

Name of Father Joseph Actine Surette MAIDEN NAME of Mother Marie Anita Bourque

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

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jean Alfred Surette Address of Applicant Tusket Date July 12, 1989

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jean AlfredSurette

Born at Sluice Point in the County of Yarmouth

That Jean AlfredSurette Whose Birth is sought to be registered was

born at Sluice Point Yarmouth County on December 29, 1924

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

Church Baptismal

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