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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000304

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary JohannaMcKenzie Sex Female

Date of Birth July 16, 1921 Place of Birth Millville, BoulardarieCounty of Cape Breton

Name of Father Dan M. McKenzie MAIDEN NAME of Mother Annie May MacDonald

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

Residence of Father when child was born Millville, Boulardarie Present address of Father Groves Point

Occupation of Father at Birth of child Miner Place of birth of Father Boulardarie Centre

Race White Name and present address of Physician in attendance at birth Dr. Nathaniel MacDonald

Signature of Applicant Mary J. McKenzie MacAulay Address of Applicant Sydney Date 28 February 1962

Relationship of Applicant to child Same Person

AFFIDAVIT

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

Born at Millville, Boulardarie in the County of Cape Breton

That Mary JohannaMcKenzie Whose Birth is sought to be registered was

born at Millville, Boulardarie Cape Breton County on July 16, 1921

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

On my Baptismal Certificate and my School Register and also on the fact that I have always regarded my birthday as the 16th of July 1921 and it was also regarded by my father and mother and the other members of my family all of whom are registered and could furnish affidavits of the date of my birth if necessary save my mother and one younger brother who are dead.

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