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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000578

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jessie AnneMacDougall Sex Female

Date of Birth January 25, 1923 Place of Birth Mount YoungCounty of Inverness

Name of Father Ronald MacDougall MAIDEN NAME of Mother Ann MacKinnon

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

Residence of Father when child was born Mount Young Inverness Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Mount Young, Inverness Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Jessie Anne Rankin Address of Applicant Mount Young, Inverness Co., NS Date 11 September 1976

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jessie AnneMacDougall

Born at Mount Young in the County of Inverness

That Jessie AnneMacDougall Whose Birth is sought to be registered was

born at Mount Young Inverness County on January 25, 1923

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

Enclosed also is a baptismal certificate showing the date of birth.

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