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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000333

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 28, 1921 Place of Birth East Lake AinslieCounty of Inverness

Name of Father Dan John MacDoougall MAIDEN NAME of Mother Minnie Margaret MacKay

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

Residence of Father when child was born East Lake Ainslie Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father East Lake Ainslie

Race White Name and present address of Physician in attendance at birth Midwife

Signature of Applicant Minnie M. MacDougall Address of Applicant Whycocomagh Date March 11, 1964

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John James DonbarMacDougall

Born at East Lake Ainslie in the County of Inverness

That John James DonbarMacDougall Whose Birth is sought to be registered was

born at East Lake Ainslie Inverness County on January 28, 1921

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

I am his Mother and have taken this from a record kept in the Family Bible

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