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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000124

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Nepean ClarkeMacDougall Sex Male

Date of Birth August 31, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Peter William MacDougall MAIDEN NAME of Mother Bessie Georgina Moffatt

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

Residence of Father when child was born 55 Charlotte Street, Sydney, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Steel Worker Place of birth of Father Loch Lomond, Richmond

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Bessie MacDougall Address of Applicant 32 Amelia Street, Sydney, Cape Breton Date 23 July 1957

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Nepean ClarkeMacDougall

Born at Sydney in the County of Cape Breton

That Nepean ClarkeMacDougall Whose Birth is sought to be registered was

born at Sydney Cape Breton County on August 31, 1922

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

I am the mother of the man whose delayed birth registration is sought. (baptism certificate attached)

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