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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000984

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Anna Rita MabelMacKenzie Sex Female

Date of Birth August 7, 1922 Place of Birth StellartonCounty of Pictou

Name of Father John Allen MacKenzie MAIDEN NAME of Mother Bertha Mabel Dickson

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

Residence of Father when child was born Stellarton, Pictou Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Sydney, Cape Breton

Race Name and present address of Physician in attendance at birth

Signature of Applicant Anna Rita Mabel Lucier Address of Applicant 242 Nelson Avenue, Penticton, British Columbia Date June 1984

Relationship of Applicant to child Myself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Anna Rita MabelMacKenzie

Born at Stellarton in the County of Pictou

That Anna Rita MabelMacKenzie Whose Birth is sought to be registered was

born at Stellarton Pictou County on August 7, 1922

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

I have always celebrated my birthday based on such date of birth. I believe that I possessed a birth certificate showing such date and had used the same to obtain a passport and when I got married but cannot now locate the certificate. Baptismal record of church.

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