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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000273

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Everett GrantMacDougall Sex Male

Date of Birth June 18, 1924 Place of Birth Blue MountainCounty of Pictou

Name of Father John Allister BMacDougall MAIDEN NAME of Mother Sophia Mary MacCulloch

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

Residence of Father when child was born Blue Mountain, Pictou Co., NS Present address of Father Blue Mountain, Pictou Co., NS

Occupation of Father at Birth of child Farmer Place of birth of Father Blue Mountain, Pictou Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant John Allister MacDougall Address of Applicant Blue Mountain, Pictou Co., NS Date 23 July 1964

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Everett GrantMacDougall

Born at Blue Mountain in the County of Pictou

That Everett GrantMacDougall Whose Birth is sought to be registered was

born at Blue Mountain Pictou County on June 18, 1924

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

I am his father

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