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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000743

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary Vina DorothyMombourquette Sex Female

Date of Birth September 15, 1921 Place of Birth New WaterfordCounty of Cape Breton

Name of Father Alfred Mombourquette MAIDEN NAME of Mother Lucy Melanson

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

Residence of Father when child was born New Waterford Present address of Father deceased

Occupation of Father at Birth of child Barber Place of birth of Father L'Ardoise

Race Name and present address of Physician in attendance at birth

Signature of Applicant Stanley J. McCormack Address of Applicant 3013 Connaught Ave. Halifax Date April 6, 1978

Relationship of Applicant to child Husband

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary Vina DorothyMombourquette

Born at New Waterford in the County of Cape Breton

That Mary Vina DorothyMombourquette Whose Birth is sought to be registered was

born at New Waterford Cape Breton County on September 15, 1921

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

Baptismal Certificate

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