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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000837

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Alexander RoderickMacKenzie Sex Male

Date of Birth March 28, 1921 Place of Birth Broad CoveCounty of Inverness

Name of Father Neil Charles MacKenzie MAIDEN NAME of Mother Catherine MacNeil

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

Residence of Father when child was born St. Rose Present address of Father deceased

Occupation of Father at Birth of child Farmer - Fisherman Place of birth of Father Charlottetown, Prince Edward Island

Race Name and present address of Physician in attendance at birth

Signature of Applicant Alex MacKenzie Address of Applicant 674 Thomson St. Inverness Date June 4, 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Alexander RoderickMacKenzie

Born at Broad Cove in the County of Inverness

That Alexander RoderickMacKenzie Whose Birth is sought to be registered was

born at Broad Cove Inverness County on March 28, 1921

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

Certificate of Baptism

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