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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000776

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary FloraMacInnis Sex Female

Date of Birth June 29, 1924 Place of Birth InvernessCounty of Inverness

Name of Father Archie MacInnis MAIDEN NAME of Mother Cecilia Burke

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

Residence of Father when child was born Inverness, NS Present address of Father Deceased

Occupation of Father at Birth of child Miner Place of birth of Father Inverness, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Florence Varrene Address of Applicant 3520 Victoria Avenue, New Waterford, Cape Breton Co., NS Date 16 February 1984

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary FloraMacInnis

Born at Inverness in the County of Inverness

That Mary FloraMacInnis Whose Birth is sought to be registered was

born at Inverness Inverness County on June 29, 1924

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

To my knowledge I was born at home

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