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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500604

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Charlotte MaryMacRae Sex Female

Date of Birth September 19, 1922 Place of Birth NyanzaCounty of Victoria

Name of Father Roderick MacRae MAIDEN NAME of Mother Lizzie MacKenzie

Residence of Father when child was born Nyanza Present address of Father Nyanza

Occupation of Father at Birth of child Farmer Place of birth of Father Middle River

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Roderick MacRae Address of Applicant Nyanza Date August 10, 1940

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Charlotte MaryMacRae

Born at Nyanza in the County of Victoria

That Charlotte MaryMacRae Whose Birth is sought to be registered was

born at Nyanza Victoria County on September 19, 1922

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

Being the Mother of the child I am in a position to know the exact Date of Birth and all the particulars relating to the circumstances

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