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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100015

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roderick JosephMacDougall Sex Male

Date of Birth May 15, 1923 Place of Birth Sydney MinesCounty of Cape Breton

Name of Father Alexander MacDougall MAIDEN NAME of Mother Christy J. MacDonnel

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

Residence of Father when child was born Sydney Mines Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Miner Place of birth of Father Port Hood, Inverness Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Roderick J. MacDougall Address of Applicant 429 Third Street, Glace Bay, Cape Breton Co., NS Date 15 January 1988

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roderick JosephMacDougall

Born at Sydney Mines in the County of Cape Breton

That Roderick JosephMacDougall Whose Birth is sought to be registered was

born at Sydney Mines Cape Breton County on May 15, 1923

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

Baptismal certificate

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