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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91900762

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Florence FaustinaMacDougall Sex Female

Date of Birth May 22, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Allan  MacDougall MAIDEN NAME of Mother Florence Anne MacGillivary

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

Residence of Father when child was born Sydney Present address of Father Sydney

Occupation of Father at Birth of child Steelworker Place of birth of Father West Arichat

Race White Name and present address of Physician in attendance at birth Dr. W.R. McRae

Signature of Applicant Florence Anne McDougall Address of Applicant Sydney Date November 23, 1945

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Florence FaustinaMacDougall

Born at Sydney in the County of Cape Breton

That Florence FaustinaMacDougall Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 22, 1920

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

I am her mother and well recall the date of my said daughter's birth

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