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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000562

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 27, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father   MAIDEN NAME of Mother Christina McInnis

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 Kalina MacDonald Address of Applicant Suite 208, 702 Gloucester, New Westminster, British Columbia Date 10 December 1975

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That KellenaMcInnis Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on January 27, 1922

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

Attached documentation: 1. Letter from Glace Bay General Hospital 2. Report of a search of Census records 3. Vaccination record - 1957 4. Certificate of marriage - 1941 5. Mothers affidavit - 1922

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