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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000268

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roy AlexanderMacKenzie Sex

Date of Birth February 16, 1923 Place of Birth Plaister MinesCounty of Victoria

Name of Father John Phillip MacKenzie MAIDEN NAME of Mother Catherine Margaret MacQueen

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

Residence of Father when child was born Plaister Mines Victoria Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Plaister Mines, Victoria Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Catherine MacKenzie Address of Applicant RR #2, Baddeck, Victoria Co., NS Date 20 July 1961

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roy AlexanderMacKenzie

Born at Plaister Mines in the County of Victoria

That Roy AlexanderMacKenzie Whose Birth is sought to be registered was

born at Plaister Mines Victoria County on February 16, 1923

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

Record of Baptism Family Bible Record Mother of Roy Alexander MacKenzie

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