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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000125

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of LewisMacInnis Sex Male

Date of Birth January 22, 1921 Place of Birth InvernessCounty of Inverness

Name of Father Dan Thomas MacInnis MAIDEN NAME of Mother Jessie  MacDonald

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

Residence of Father when child was born Inverness Present address of Father Inverness

Occupation of Father at Birth of child Blacksmith Place of birth of Father Judique

Race Scottish Name and present address of Physician in attendance at birth Dr. MacMaster

Signature of Applicant Lewis MacInnis Address of Applicant 18 Tobin St. Halifax Date June 16, 1950

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of LewisMacInnis

Born at Inverness in the County of Inverness

That LewisMacInnis Whose Birth is sought to be registered was

born at Inverness Inverness County on January 22, 1921

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

Certificate of Baptism attached.

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