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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600882

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Evelyn JessieMacKenzie Sex Female

Date of Birth December 20, 1920 Place of Birth Kempt HeadCounty of Victoria

Name of Father John William MacKenzie MAIDEN NAME of Mother Lena Jane Macdonald

Residence of Father when child was born Kempt Head Present address of Father Kempt Head

Occupation of Father at Birth of child Farming Place of birth of Father Kempt Head

Race Scottish Name and present address of Physician in attendance at birth Mrs. Christine McKay, Nurse

Signature of Applicant J.W. MacKenzie Address of Applicant Ross Ferry Date June 18, 1936

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Evelyn JessieMacKenzie

Born at Kempt Head in the County of Victoria

That Evelyn JessieMacKenzie Whose Birth is sought to be registered was

born at Kempt Head Victoria County on December 20, 1920

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

From record in 'Family Record'

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