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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000299

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 22, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father Daniel James 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, Cape Breton Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Annie MacKenzie Address of Applicant 4 Stinson Street, Hamilton, Ontario Date 27 August 1963

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That WilburnMacKenzie Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on October 22, 1922

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

I delivered a male child at the Glace Bay General Hospital while being attended by Dr. A. Calder, which child was subsequently christened Wilburn MacKenzie at the United Church, Port Morien, Cape Breton

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