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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000985

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth March 9, 1924 Place of Birth SydneyCounty of Cape Breton

Name of Father Peter William MacDougall MAIDEN NAME of Mother Bessie Georgina Moffat

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 Loch Lomond

Race Name and present address of Physician in attendance at birth

Signature of Applicant M.H. Pierre Address of Applicant 3-332 Chisholm Ave. Toronto, Ontario Date March 22, 1999

Relationship of Applicant to child Myself

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That Annie MadgeMacDougall Whose Birth is sought to be registered was

born at Sydney Cape Breton County on March 9, 1924

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

Shown documents marriage certificate, baptismal record

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