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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100094

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Francis AugustineMombourquette Sex Male

Date of Birth May 27, 1921 Place of Birth Lower L'ArdoiseCounty of Richmond

Name of Father James Mombourquette MAIDEN NAME of Mother Minnie Samson

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

Residence of Father when child was born Lower L'Ardoise Present address of Father deceasaed

Occupation of Father at Birth of child Fisherman Place of birth of Father Lower L'Ardoise

Race Name and present address of Physician in attendance at birth

Signature of Applicant Francis A. Mombourquette Address of Applicant Lower L'Ardoise Date March 1985

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Francis AugustineMombourquette

Born at Lower L'Ardoise in the County of Richmond

That Francis AugustineMombourquette Whose Birth is sought to be registered was

born at Lower L'Ardoise Richmond County on May 27, 1921

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

That I am 88 years of age and was and still am a next door neighbour. I was living in the Lower L'Ardoise area when Francis Augustine Mombourquette was born on the 27th day of May 1921.

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