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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100184

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Henrietta MargaretMacKenzie Sex Female

Date of Birth November 17, 1921 Place of Birth DiamondCounty of Pictou

Name of Father Daniel Kenneth MacKenzie MAIDEN NAME of Mother Christena Jane Wal

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

Residence of Father when child was born Diamond Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father West Branch

Race Name and present address of Physician in attendance at birth

Signature of Applicant Henrietta Margaret MacKenzie Address of Applicant RR1 Scotsburn Date August 25, 1986

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Henrietta MargaretMacKenzie

Born at Diamond in the County of Pictou

That Henrietta MargaretMacKenzie Whose Birth is sought to be registered was

born at Diamond Pictou County on November 17, 1921

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

1) Information given me by my parents 2) Census Records 3) National Registration Records

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