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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700240

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of AnnieMcDougall Sex Female

Date of Birth December 11, 1919 Place of Birth BenacadieCounty of Cape Breton

Name of Father Archie J McDougall MAIDEN NAME of Mother Margaret McKenzie

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

Residence of Father when child was born Benacadie West Present address of Father

Occupation of Father at Birth of child Painter Place of birth of Father Cape Breton Co.

Race Name and present address of Physician in attendance at birth

Signature of Applicant Archie J. McDougall Address of Applicant Benacadie West Date 18 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of AnnieMcDougall

Born at Benacadie in the County of Cape Breton

That AnnieMcDougall Whose Birth is sought to be registered was

born at Benacadie Cape Breton County on December 11, 1919

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

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