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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000787

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bernard HilaryMacKenzie Sex Male

Date of Birth August 25, 1923 Place of Birth DominionCounty of Cape Breton

Name of Father Joseph MacKenzie MAIDEN NAME of Mother Agnes Gillis

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

Residence of Father when child was born Dominion Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Joggins, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Bernard H. McKenzie Address of Applicant 1574 Venetia Drive, Oakville, Ontario Date 29 July 1980

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bernard HilaryMacKenzie

Born at Dominion in the County of Cape Breton

That Bernard HilaryMacKenzie Whose Birth is sought to be registered was

born at Dominion Cape Breton County on August 25, 1923

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

Enclosed certificate of baptism I requested a birth certificate for Bernard H. McKenzie - perhaps my birth was registered as Bernard H. MacKenzie

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