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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100192

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Benjamin EarleJardine Sex Male

Date of Birth July 2, 1920 Place of Birth FlorenceCounty of Cape Breton

Name of Father Thomas Waddell Jardine MAIDEN NAME of Mother Christine Martin

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

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

Occupation of Father at Birth of child Coal miner Place of birth of Father Florence

Race Name and present address of Physician in attendance at birth

Signature of Applicant Benjamin Earle Jardine Address of Applicant Sydney Mines Date November 10, 1982

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Benjamin EarleJardine

Born at Florence in the County of Cape Breton

That Benjamin EarleJardine Whose Birth is sought to be registered was

born at Florence Cape Breton County on July 2, 1920

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

I am enclosing a copy of "Certificate of Birth"

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