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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600682

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 7, 1922 Place of Birth North RiverCounty of Victoria

Name of Father Max Louis Heinz MAIDEN NAME of Mother Barbara Montgomery

Residence of Father when child was born North Ogden Street, Buffalo, New York, USA Present address of Father 522 Hewitt Avenue, Buffalo, New York, USA

Occupation of Father at Birth of child Railroad Switchman Place of birth of Father New York City, New York, USA

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Max L. Heinz Address of Applicant 522 Hewitt Avenue, Buffalo, New York, USA Date 28 March 1936

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at North River in the County of Victoria

That Daniel AlexanderHeinz Whose Birth is sought to be registered was

born at North River Victoria County on March 7, 1922

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

That he is my son. I was living with my father at that time having come home from Buffalo in September 1921.

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