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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000756

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of McKenzie BurnsFalconer Sex Male

Date of Birth January 3, 1924 Place of Birth Caribou RiverCounty of Pictou

Name of Father McKenzie Falconer MAIDEN NAME of Mother Christina MacKay

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

Residence of Father when child was born Caribou River, Pictou Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant McKenzie Falconer Address of Applicant RR #2, Scotsburn, Pictou Co., NS Date 11 July 1983

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of McKenzie BurnsFalconer

Born at Caribou River in the County of Pictou

That McKenzie BurnsFalconer Whose Birth is sought to be registered was

born at Caribou River Pictou County on January 3, 1924

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

Baptismal Extract of marriage

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