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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000899

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 15, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Donald J. MacKenzie MAIDEN NAME of Mother Annie Williams

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

Residence of Father when child was born Glace Bay Present address of Father Glace Bay

Occupation of Father at Birth of child Miner Place of birth of Father Whycocomagh

Race Canadian Name and present address of Physician in attendance at birth Dr. Calder

Signature of Applicant Annie MacKenzie Address of Applicant Clementsport Date January 11, 1956

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That AlbertMacKenzie Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on September 15, 1921

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

School Record. Marriage Record.

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