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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000789

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Florence JeanetteMcInnis Sex Female

Date of Birth February 17, 1923 Place of Birth Cross Roads, OhioCounty of Antigonish

Name of Father Dan J. McInnis MAIDEN NAME of Mother Gertrude McLean

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

Residence of Father when child was born Cross Roads Ohio Antigonish Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Cross Roads, Ohio, Antigonish Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Gertrude D. McInnis Address of Applicant Cross Roads, Ohio, Antigonish Co., NS Date 1 August 1980

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Florence JeanetteMcInnis

Born at Cross Roads, Ohio in the County of Antigonish

That Florence JeanetteMcInnis Whose Birth is sought to be registered was

born at Cross Roads, Ohio Antigonish County on February 17, 1923

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

I am her mother

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