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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000343

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Daniel AlexanderHeinz Sex Male

Date of Birth March 9, 1922 Place of Birth Meadow, North RiverCounty of Victoria

Name of Father Max Lang Heinz MAIDEN NAME of Mother Barbara Jessie Montgomery

Residence of Father when child was born 207 North Ogden Street, Buffalo, New York Present address of Father 207 North Ogden Street, Buffalo, New York

Occupation of Father at Birth of child Carpenter Place of birth of Father New York State, USA

Race Name and present address of Physician in attendance at birth

Signature of Applicant Barbara Jessie Montgomery Address of Applicant Meadow, Victoria Date 11 April 1922

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Daniel AlexanderHeinz

Born at Meadow, North River in the County of Victoria

That Daniel AlexanderHeinz Whose Birth is sought to be registered was

born at Meadow, North River Victoria County on March 9, 1922

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

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