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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000754

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of JeanDumont Sex Female

Date of Birth August 30, 1920 Place of Birth ThorburnCounty of Pictou

Name of Father John  Dumont MAIDEN NAME of Mother Mary LeRoy

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

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

Occupation of Father at Birth of child coal miner Place of birth of Father Ham-sur-Sambre, Belgium

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jean McTiernan Address of Applicant Minto, New Brunswick Date November 1, 1975

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of JeanDumont

Born at Thorburn in the County of Pictou

That JeanDumont Whose Birth is sought to be registered was

born at Thorburn Pictou County on August 30, 1920

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

It was always understood and agreed to by my parents and all of my family that the date shown hereon was factual. I also possess a Certificate of Birth and Baptism showing the Date of Birth as such and I was baptized on February 1, 1921

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