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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100224

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Daniel CharlesMacDougall Sex Male

Date of Birth April 3, 1921 Place of Birth AntigonishCounty of Antigonish

Name of Father Hugh MacDougall MAIDEN NAME of Mother Mary Jane Smith

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

Residence of Father when child was born Antigonish Present address of Father

Occupation of Father at Birth of child Place of birth of Father Springfield

Race Name and present address of Physician in attendance at birth

Signature of Applicant John Hugh MacDougall Address of Applicant 60 Braemore Ave, Antigonish Date May 5, 1994

Relationship of Applicant to child Brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Daniel CharlesMacDougall

Born at Antigonish in the County of Antigonish

That Daniel CharlesMacDougall Whose Birth is sought to be registered was

born at Antigonish Antigonish County on April 3, 1921

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

Baptismal School Records

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