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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000546

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Stanley FrankMacKenzie Sex Male

Date of Birth December 6, 1923 Place of Birth Upper North RiverCounty of Colchester

Name of Father   MAIDEN NAME of Mother Christena MacKenzie

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Stanley F. MacKenzie Address of Applicant RR# 6 Upper North River Date 15 December 1975

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Stanley FrankMacKenzie

Born at Upper North River in the County of Colchester

That Stanley FrankMacKenzie Whose Birth is sought to be registered was

born at Upper North River Colchester County on December 6, 1923

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

1) School Attendance Record 2) Census Record

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