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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91703791

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary JeanetteMacKenzie Sex

Date of Birth June 12, 1920 Place of Birth StellartonCounty of Pictou

Name of Father Angus Simon MacKenzie MAIDEN NAME of Mother Janet Martin

Residence of Father when child was born Rundle Street, Stellarton Present address of Father 112 Hospital Avenue, New Glasgow

Occupation of Father at Birth of child Locomotive Engineer Place of birth of Father Boularderie

Race Canadian Scottish Name and present address of Physician in attendance at birth Dr. Clarence Miller, 87 Stellarton Road, New Glasgow

Signature of Applicant Janet (Mrs. A.S.) MacKenzie Address of Applicant 112 Hospital Avenue, New Glasgow Date July 7, 1943

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary JeanetteMacKenzie

Born at Stellarton in the County of Pictou

That Mary JeanetteMacKenzie Whose Birth is sought to be registered was

born at Stellarton Pictou County on June 12, 1920

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

I am the mother of Mary Jeanette MacKenzie.

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