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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000627

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 18, 1921 Place of Birth Sydney County of Cape Breton

Name of Father Daniel F. MacInnis MAIDEN NAME of Mother Mary MacKenzie

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

Residence of Father when child was born Sydney Present address of Father died 31 Oct 1964

Occupation of Father at Birth of child Carpenter Place of birth of Father Iona

Race Name and present address of Physician in attendance at birth

Signature of Applicant R.M. MacPherson Address of Applicant Havre Boucher Date March 15, 1976

Relationship of Applicant to child Husband

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That Mary HeleneMacInnis Whose Birth is sought to be registered was

born at Sydney Cape Breton County on September 18, 1921

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

That I have seen the attached Certificate of Birth and Baptism

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