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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

65400257

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of James B.MacIntosh Sex Male

Date of Birth January 4, 1924 Place of Birth Glace BayCounty of Cape Breton

Name of Father Edward R. MacIntosh MAIDEN NAME of Mother Sadie McDonald

Residence of Father when child was born Glace Bay, Cape Breton Co., NS Present address of Father Bangor, Maine, USA

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. E. R. McIntosh Address of Applicant Glace Bay, Cape Breton Co., NS Date 10 November 1926

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of James B.MacIntosh

Born at Glace Bay in the County of Cape Breton

That James B.MacIntosh Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on January 4, 1924

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

I am his mother

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