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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100287

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marjorie BlancheJacklin Sex Female

Date of Birth December 23, 1920 Place of Birth ShelburneCounty of Shelburne

Name of Father Arthur Leslie Jacklin MAIDEN NAME of Mother Edith Blanche Jacklin

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 Blacksmith Place of birth of Father Shelburne

Race Name and present address of Physician in attendance at birth

Signature of Applicant W. Inard Address of Applicant Halifax Date November 9, 1984

Relationship of Applicant to child Brother-in-law

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marjorie BlancheJacklin

Born at Shelburne in the County of Shelburne

That Marjorie BlancheJacklin Whose Birth is sought to be registered was

born at Shelburne Shelburne County on December 23, 1920

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

Baptism Census Canada National Registration

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