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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000711

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Robie AdelbertJackson Sex Male

Date of Birth February 27, 1920 Place of Birth ShelburneCounty of Shelburne

Name of Father Albert L. Jackson MAIDEN NAME of Mother Chrissie M. Jackson

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

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

Occupation of Father at Birth of child Saw Mill Worker Place of birth of Father Shelburne

Race Name and present address of Physician in attendance at birth

Signature of Applicant R.A. Jackson Address of Applicant Shearwater Date December 4, 1974

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Robie AdelbertJackson

Born at Shelburne in the County of Shelburne

That Robie AdelbertJackson Whose Birth is sought to be registered was

born at Shelburne Shelburne County on February 27, 1920

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

Baptismal Certificate

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