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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000569

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 26, 1924 Place of Birth Glace BayCounty of Cape Breton

Name of Father   MAIDEN NAME of Mother Emily Mary MacLeod

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

Residence of Father when child was born Present address of Father Deceased

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 Florence M. McKinnon Address of Applicant 390 Southdale Road East, Apt. 711, London, Ontario Date 3 April 1978

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That Florence MabelMacLeod Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on January 26, 1924

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

I am one and the same as Florence Mabel MacLeod. I have been informed by my relatives that the date of my birth is as stated. I am also informed by a certificate from the Glace Bay General Hospital that my date of birth is as stated.

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