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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000135

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of AdaMacKinnon Sex Female

Date of Birth March 7, 1922 Place of Birth Bras D'OrCounty of Cape Breton

Name of Father   MAIDEN NAME of Mother Annie MacKinnon

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant S. D. Perez Address of Applicant 12 Morris Street, Halifax Date 12 February 1952

Relationship of Applicant to child None

AFFIDAVIT

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

Born at Bras D'Or in the County of Cape Breton

That AdaMacKinnon Whose Birth is sought to be registered was

born at Bras D'Or Cape Breton County on March 7, 1922

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

certificate of baptism (attached)

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