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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100118

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John ColinMacInnis Sex Male

Date of Birth May 7, 1922 Place of Birth WestfieldCounty of Queens

Name of Father Leith Andrew MacInnis MAIDEN NAME of Mother Effie Estelle Smith

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

Residence of Father when child was born Westfield Present address of Father deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Nictaux Falls

Race Name and present address of Physician in attendance at birth

Signature of Applicant Effie MacInnis Address of Applicant Caledonia Date 16 February 1979

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John ColinMacInnis

Born at Westfield in the County of Queens

That John ColinMacInnis Whose Birth is sought to be registered was

born at Westfield Queens County on May 7, 1922

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

Based on Marriage, School extract and top portion of this delayed form signed by the Mother

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