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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000981

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Irene Elizabeth DorothyMombourquette Sex Female

Date of Birth January 24, 1924 Place of Birth HalifaxCounty of Halifax

Name of Father Arthur Mombourquette MAIDEN NAME of Mother Lucie Melanson

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 L'Ardoise

Race Name and present address of Physician in attendance at birth

Signature of Applicant Irene Elizabeth Dorothy Mombourquette Address of Applicant 240 Main Ave. Halifax Date July 21, 1995

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Irene Elizabeth DorothyMombourquette

Born at Halifax in the County of Halifax

That Irene Elizabeth DorothyMombourquette Whose Birth is sought to be registered was

born at Halifax Halifax County on January 24, 1924

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

Baptismal Marriage Extract

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