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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000374

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John JosephMacKenzie Sex Male

Date of Birth March 24, 1921 Place of Birth Pipers GlenCounty of Inverness

Name of Father Hugh  MacKenzie MAIDEN NAME of Mother Flora MacDonnell

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

Residence of Father when child was born Pipers Glen Present address of Father Pipers Glen

Occupation of Father at Birth of child Farmer Place of birth of Father Pipers Glen

Race Anglo-Saxon Name and present address of Physician in attendance at birth

Signature of Applicant John Joseph MacKenzie Address of Applicant 78 Newlin Ave. Toronto, Ontario Date 12 May 1967

Relationship of Applicant to child Applicant is person whose birth is being registerd

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John JosephMacKenzie

Born at Pipers Glen in the County of Inverness

That John JosephMacKenzie Whose Birth is sought to be registered was

born at Pipers Glen Inverness County on March 24, 1921

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

My parents statements to me and my Baptismal Certificate - Affixed as Exhibit A to this my affidavit

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