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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100413

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Dorothy MayJack Sex Female

Date of Birth April 7, 1920 Place of Birth SonoraCounty of Guysborough

Name of Father William Jack MAIDEN NAME of Mother Nora Belle Caleo

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

Residence of Father when child was born Sonora Present address of Father

Occupation of Father at Birth of child Place of birth of Father Sonora

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dorothy May Jack Address of Applicant Sherbrooke Date August 11, 2000

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Dorothy MayJack

Born at Sonora in the County of Guysborough

That Dorothy MayJack Whose Birth is sought to be registered was

born at Sonora Guysborough County on April 7, 1920

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

School Record/Census Report

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