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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000656

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Douglad ArchyMacIntyre Sex Male

Date of Birth November 20, 1923 Place of Birth InvernessCounty of Inverness

Name of Father Dan MacIntyre MAIDEN NAME of Mother Catherine MacDonnell

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

Residence of Father when child was born Inverness Ns Present address of Father Dead

Occupation of Father at Birth of child Miner Place of birth of Father Inverness, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Donald Archy MacIntyre Address of Applicant Box 360, Westville, Pictou Co., NS Date 3 July 1978

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Douglad ArchyMacIntyre

Born at Inverness in the County of Inverness

That Douglad ArchyMacIntyre Whose Birth is sought to be registered was

born at Inverness Inverness County on November 20, 1923

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

that I had always been told by my parents that I was born on November 20, 1923 and believe it to be true.

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