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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700090

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John AlfredMcDougall Sex Male

Date of Birth December 18, 1919 Place of Birth Sydney MinesCounty of Cape Breton

Name of Father John McDougall MAIDEN NAME of Mother Dorothy Pearl Roberts

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

Residence of Father when child was born Sydney Mines Present address of Father Pond St.

Occupation of Father at Birth of child Barber Place of birth of Father North Sydney

Race Name and present address of Physician in attendance at birth Dr. D.W. Archibald

Signature of Applicant Dorothy Pearl McDougall Address of Applicant Sydney Mines Date 14 January 1920

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John AlfredMcDougall

Born at Sydney Mines in the County of Cape Breton

That John AlfredMcDougall Whose Birth is sought to be registered was

born at Sydney Mines Cape Breton County on December 18, 1919

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

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