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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200271

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Eva MayJackson Sex Female

Date of Birth November 19, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father William Henry Jackson MAIDEN NAME of Mother Catherine Agnes Leavy

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

Residence of Father when child was born Halifax Present address of Father 21 Brunswick St.

Occupation of Father at Birth of child Chauffeur Place of birth of Father New York City, NY

Race Name and present address of Physician in attendance at birth Dr. L.L. Harrison

Signature of Applicant William Henry Jackson Address of Applicant 21 Brunswick St. Date 20 December 1919

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Eva MayJackson

Born at Halifax in the County of Halifax

That Eva MayJackson Whose Birth is sought to be registered was

born at Halifax Halifax County on November 19, 1919

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

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