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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100074

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Annie ChristinaGoogoo Sex Female

Date of Birth March 26, 1923 Place of Birth Whycocomagh ReserveCounty of Inverness

Name of Father Sam Googoo MAIDEN NAME of Mother Sarah Bernard

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

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Annie C. Simon Address of Applicant RR #1 Afton Reserve Date March 9, 1995

Relationship of Applicant to child Herself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Annie ChristinaGoogoo

Born at Whycocomagh Reserve in the County of Inverness

That Annie ChristinaGoogoo Whose Birth is sought to be registered was

born at Whycocomagh Reserve Inverness County on March 26, 1923

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

Certificate of Baptism

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