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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000536

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Donald RaymondMacKenzie Sex Male

Date of Birth July 8, 1923 Place of Birth Caribou RiverCounty of Pictou

Name of Father Gordon MacKenzie MAIDEN NAME of Mother Margaret McTavish

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

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

Occupation of Father at Birth of child Farmer Place of birth of Father Pictou

Race Name and present address of Physician in attendance at birth

Signature of Applicant R.R. MacKenzie Address of Applicant Box 664 Lillouet, British Columbia Date September 18, 1975

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Donald RaymondMacKenzie

Born at Caribou River in the County of Pictou

That Donald RaymondMacKenzie Whose Birth is sought to be registered was

born at Caribou River Pictou County on July 8, 1923

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

Baptismal Certificate

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