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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000531

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John DanMacDougall Sex Male

Date of Birth January 24, 1924 Place of Birth MabouCounty of Inverness

Name of Father John MacDougall MAIDEN NAME of Mother Mary C. MacLean

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

Residence of Father when child was born Mabou, Inverness Co., NS Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant John Dan MacDougall Address of Applicant 470 Elizabeth Road, Campbell River, British Columbia Date 15 February 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John DanMacDougall

Born at Mabou in the County of Inverness

That John DanMacDougall Whose Birth is sought to be registered was

born at Mabou Inverness County on January 24, 1924

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

Certificate of baptism - as previously recorded by your office

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