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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000385

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of George StanleyMombourquette Sex Male

Date of Birth March 25, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Dave Mombourquette MAIDEN NAME of Mother Mary Margaret Doucette

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

Residence of Father when child was born MacLeods Hill, Whitney Pier Present address of Father deceased

Occupation of Father at Birth of child Miner Place of birth of Father Nova Scotia

Race French Name and present address of Physician in attendance at birth deceased

Signature of Applicant G.S. Mombourquette Address of Applicant Calgary, Alberta Date 8 July 1968

Relationship of Applicant to child same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of George StanleyMombourquette

Born at Sydney in the County of Cape Breton

That George StanleyMombourquette Whose Birth is sought to be registered was

born at Sydney Cape Breton County on March 25, 1921

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

Certificate of Baptism from the Holy Redeemer Parish, Sydney, Nova Scotia and information from my parents while I was living at home.

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