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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000693

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of AgnesMcKenzie Sex Female

Date of Birth April 13, 1923 Place of Birth DonkinCounty of Cape Breton

Name of Father   MAIDEN NAME of Mother Agnes C. McKenzie

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 Agnes MacKenzie Hennessey Address of Applicant 87 Ferris Street, Sydney, Cape Breton Co., NS Date 26 January 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of AgnesMcKenzie

Born at Donkin in the County of Cape Breton

That AgnesMcKenzie Whose Birth is sought to be registered was

born at Donkin Cape Breton County on April 13, 1923

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

Baptismal certificate

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