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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100190

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of DavidJoseph Sex Male

Date of Birth January 23, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Peter Joseph MAIDEN NAME of Mother Mary Jacobs

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 not known Place of birth of Father not known

Race Name and present address of Physician in attendance at birth

Signature of Applicant Walter E. Jackson Address of Applicant Cole Harbour Date November 23, 1982

Relationship of Applicant to child friend

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That DavidJoseph Whose Birth is sought to be registered was

born at Sydney Cape Breton County on January 23, 1920

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

1. Census Report 2. School Extract 3. Legal Affadavit alluding to place of birth

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