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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000951

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roy AllisonMacInnis Sex Male

Date of Birth February 26, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father Alfred MacInnis MAIDEN NAME of Mother Florence Skeard

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

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

Occupation of Father at Birth of child Carpenter Place of birth of Father Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant Shirley Lorraine MacInnis Address of Applicant 64 Chadwick Place Halifax Date December 3, 1981

Relationship of Applicant to child Niece

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roy AllisonMacInnis

Born at Glace Bay in the County of Cape Breton

That Roy AllisonMacInnis Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on February 26, 1921

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

Baptismal

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