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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000543

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Daisy Mae IdabelleJackson Sex Female

Date of Birth November 25, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Joseph Jackson MAIDEN NAME of Mother Ida Beatrice Paris

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

Residence of Father when child was born Sydney Present address of Father deceased

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

Race Negro Name and present address of Physician in attendance at birth

Signature of Applicant Eva I. Maxwell Address of Applicant Truro Date April 3, 1971

Relationship of Applicant to child sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Daisy Mae IdabelleJackson

Born at Sydney in the County of Cape Breton

That Daisy Mae IdabelleJackson Whose Birth is sought to be registered was

born at Sydney Cape Breton County on November 25, 1920

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

1. School level record 2. National Legislation

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